Inspection on 21/11/08 for Sandmartins

This inspection was carried out on 21st November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sandmartins 22/11/06

Sandmartins 01/02/06

Sandmartins 18/08/05

Sandmartins 18/01/05

Sandmartins 18/08/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sandmartins Kings Parade Aldwick Bognor Regis West Sussex PO21 2QY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Webb     Date: 2 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Sandmartins Kings Parade Aldwick Bognor Regis West Sussex PO21 2QY 01243864031 F/P01243864031 sandmartins@saffronland.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Homebeech Ltd care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users ot be accommodated is 14 The registered person may provide the following category of service only: Care home only (PC) to service suers of the following gender: Either Whose primary care needs on admisison to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Sandmartins is a care home registered to provide accommodation and personal care for fourteen residents in the category of old age, not falling within any other category. The registered provider is Homebeech Limited for whom the responsible individual is Ms R Page. The registered manager in charge of the day-to-day running of the home is Mrs. P Pink. The property is a large detached building, situated in a quiet residential area overlooking a park very close to the seafront in Bognor Regis. Local shops are nearby. Accommodation is provided on two floors, communal space consisting of a lounge area, dining room, sun lounge and large garden to the rear of the building. Private accommodation consists of 14 single bedrooms. The current scale of fees being Care Homes for Older People Page 4 of 29 Over 65 14 0 Brief description of the care home charged at the home is from three hundred and fifty pounds to five hundred pounds. It should be noted that any fee information included in this report applied at the time of inspection and that people may wish to obtain more up to date information from the care home. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We undertook this inspection over one day, with the home being given no prior notice that we would be visiting. During the inspection time was spent talking to residents, staff and the Registered Manager. We also case tracked two residents care. This involves talking to the resident, observing care practices and examining records relating to the care and support they receive. In addition to this we also examined other records, talked to relatives of a resident and observed support given to other residents. The home also completed its Annual Quality Assurance Assessment (AQAA) and sent this to us prior to our inspection. The contents of this were assessed and used when forming judgements on the standards of service provided and outcomes for residents. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Improvements must be made to the management of diabetes. This must include ensuring consistent monitoring of blood sugar levels and improving staffs understanding of safe blood sugar levels. This must happen so that residents health needs are met safely. Care Homes for Older People Page 8 of 29 A record must be maintained in the home of the date when CRB disclosures have been obtained, the level of disclosure and this must be signed as accurate by either the Registered Manager or Registered Individual. If recruitment records are to be stored away from the home, written agreement must be obtained with CSCI and information maintained as detailed in CSCI CRB policy guidance issued October 2008. This must happen in order that the home can evidence its recruitment practices safeguard residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to prospective residents in order to help them decide if the home will meet their needs. Assessment processes ensure residents needs are known to staff. Prospective residents have the opportunity to visit the home before moving in so that they can decide if it will meet their needs. Evidence: Information about the home is provided to new residents in the form of a Welcome Pack. On the day of our site visit the Registered Manager informed us this has recently been updated and is in the process of being given to all residents. The Welcome Pack includes information about visitors, meals, laundry, security, personal affects, activities, quality assurance, complaints and health and safety. This information assists prospective residents to make a choice about the suitability of the home. Care Homes for Older People Page 11 of 29 Evidence: The Registered Manager confirmed that all new residents have their needs assessed either before they move into the home or on admission if this has taken place at short notice. We were shown a document titled This Is Your Life. The Registered Manager stated that this is going to be completed when new residents move to the home in order that further information is known about new residents. This document asks for information on peoples past life experiences and memories. We examined two residents files. They both included a documented assessment of needs that had been used to develop plans of care. We noted that some sections of the homes assessment documentation were incomplete. The Registered Manager stated this was an oversight when information has been transferred during review processes. Four residents were spoken to. All confirmed either they or their representatives had visited the home before moving there, in order to decide if it was suitable for them. One resident said, my son and daughter in law came and looked and liked, said others here chatty and would I like to come and look around. I did and liked what I saw, chose this room, I fit in better here. Sandmartins does not provide intermediate care, although periods of respite care can be offered. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning systems give clear information so that staff have the information needed to support residents. Not all residents health needs are being met safely. Medication systems offer safeguards to residents. Residents are treated with dignity and their rights to privacy respected. Staff have received training that helps them deal sensitively with death and the dying. Evidence: As at previous inspections all residents have a plan of care, which has been developed from their assessment of needs. We looked at care planning documentation for two residents and found both to give information in a concise way that helps the reader understand what support each resident needs. Plans were seen to be in place for all aspects of care including physical needs, health care and emotional care. Records evidence that plans are reviewed monthly to show changing needs of residents. Care Homes for Older People Page 13 of 29 Evidence: One residents file that we looked at contained a care plan for the management of diabetes. This instructs that blood sugar levels should be monitored regularly and that the resident should receive regular chiropody care. We asked the Registered Manager how often blood sugar levels should be monitored and she stated once or twice a week. The monitoring records do not reflect this information. For example in October they were checked three times and in November they have not been checked at all. In addition to the Registered Manager, we spoke to two members of staff and received varying information about how often the residents blood sugar levels should be monitored and what range these should be maintained within so that they are safe. We informed the Registered Manager that improvements must be made with regard to the management of this residents diabetes including ensuring consistent monitoring and improving staffs understanding so that the resident is not placed at risk. The Registered Manager agreed to contact the diabetes nurse and arrange for an assessment to be undertaken and advice to be obtained. In addition to care plans for specific needs, assessments are undertaken for the prevention of falls, pressure sores, moving and handling and incontinence. When case tracking two residents care we found no evidence that nutritional screening had taken place. We discussed this with the Registered Manager who informed us this is not completed for residents stating, we would just monitor eg if diabetic would stick to diet. If worried would liaise with GP or contact dietitian at hospital. She was unable to explain how nutritional needs would be identified for undiagnosed conditions and said that it would be an idea to include nutritional assessments as part of the initial needs assessment undertaken when residents move into the home. We spoke to three residents, with all confirming their satisfaction about the support they receive to maintain good health. All explained they receive regular attention from health professionals including opticians, chiropodists and general practitioners. We looked at the medication records for the two residents that we case tracked. Both were up to date and accurate. Records seen include those for medication entering the home and being administered. The home uses a monitored dosage system, with medication stored in a lockable medicine trolley. This was seen to be chained to the wall in an office. At the time of our visit the Registered Manager informed us there is one resident prescribed Controlled Drugs. We saw that a record of this is maintained in a bound Controlled Drugs Register and the medication stored in a Controlled Drugs cabinet. During our visit staff were observed knocking on bedroom doors and seeking approval before entering. This practice promotes residents rights to privacy. A resident also Care Homes for Older People Page 14 of 29 Evidence: informed us of their satisfaction that same gender support is provided with personal care. Residents expressed satisfaction with support given by the home to promote their personal hygiene care. As one resident explained, the hairdresser visits every Tuesday, yesterday I had feet done by chiropodist and have a nail lady, paint nails, makes you feel good. Records confirm five staff have received training relating to funeral arrangements and three in palliative care. This helps ensure staff have the necessary skills to support residents at the end of life. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a lifestyle that respects privacy, dignity and choice, matching residents expectations and individual preferences. Activities are offered and residents are encouraged to be part of the community. Home cooked food is provided, with choices of alternatives available that meet residents needs. Evidence: As at previous inspections an abundance of evidence finds that residents are provided with a range of activities that suit their individual needs. All residents that we spoke to expressed satisfaction with activities provided by the home. One person explained, we have sing songs, shows in the lounge, yesterday we had young lady with guitar, very nice. Another lady and man play the electric organ and a young fella gives us exercise with rubber balls and tube that we squeeze like a lemon, helps keep fingers active. A notice board in the lounge displays the details of forthcoming events. These include quizzes, organ music, exercise sessions, music for health and bingo. Care Homes for Older People Page 16 of 29 Evidence: During our visit we spoke to relatives of one resident. They confirmed their satisfaction with the home explaining that they are always made welcome, that there are no restrictions on visiting times and that they are always kept informed of their relatives wellbeing. All residents that we spoke to confirmed their satisfaction with meals provided. Comments made include, the cook is very good, makes wonderful cakes, have a choice at breakfast, lunch and dinner, can have meals in room if choose and meals are marvelous, the chef is wonderful. One resident did inform us that they would like pork chops to be offered more frequently and for lamb chops to be added to the menu. We passed this information to the Registered Manager who agreed to arrange for this. We indirectly observed lunch. Many residents were seen to have this meal in the dining room, which is bright, well furnished and inviting. The atmosphere between residents and staff was sociable. Other residents chose to have their meal in their bedrooms. During the day staff were observed seeking residents preferences with regards to meals including offering choices other than those on the menu. One resident informed us, they appreciate you, know your likes and dislikes. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel confident to raise concerns, that these will be taken seriously and responded to. Safeguarding procedures ensure residents are protected from harm. Staff understand their responsibility to safeguard residents. Evidence: The complaints procedure is on display at the entrance to the home and on the residents noticeboard in the lounge. This gives an assurance that complaints will be dealt with within 28 days. We were informed by the Registered Manager that there have been no complaints received by the home during the last twelve months. All residents that we spoke to confirmed they would feel confident to raise concerns. For example one person explained, if unhappy I would bring it up, the staff so lovely they do their best. The Registered Manager produced a training matrix that details six of the fourteen staff who work at the home having received training in adult protection. A copy of West Sussex Multi Agency guidelines is available in the home for reporting abuse. Care Homes for Older People Page 18 of 29 Evidence: Staff that we spoke to demonstrated understanding of protection. For example one person explained, its important to listen to residents, look at reactions to staff and other residents. Report any concerns to management. If not happy, take higher to area manager. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is clean and well maintained, providing residents with a comfortable and safe place to live. Bedrooms are well equipped and meet residents needs. Equipment is provided that promotes good infection control. Evidence: The property is situated in a residential area of Bognor Regis, close to the sea and overlooking a park. There are parking facilities to the front of the home and an enclosed garden to the rear. A ramp is located at the entrance to the home in order that it is wheelchair accessible. On the day of our visit all communal areas and four of the fourteen bedrooms were seen. All areas were observed to be clean and well maintained. Residents that we spoke to confirmed efforts have been made to personalize their bedrooms. As one person explained, the maintenance man put selfs up to make it feel more like home and pictures, its great. Another resident said, I love my room, I have a lovely view of the sea. Hand washing signage, liquid soap and paper towels were seen to be in place in Care Homes for Older People Page 20 of 29 Evidence: communal toilets. These promote good infection control. A resident expressed satisfaction with regard to the laundering of personal items, stating, staff are marvelous with laundry, dont have to worry, they dont spoil things, its very clean here. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by suitable numbers of qualified staff. Residents are not protected in full by some recruitment records. The staff training programme provides staff with the skills they need to do their job. Evidence: The Registered Manager informed us that two care staff are allocated to each morning and afternoon shift in addition to herself or the deputy and that two staff are on duty during the night. In addition to this the home employs a chef and a supper cook. Six hours a week are allocated for deep cleaning within the home, with all other cleaning undertaken by the care staff on duty. Residents that we spoke to expressed satisfaction with staff working at the home. For example one person said, staff all good, work hard, like their jobs and another staff really really good, very kind. We viewed a training matrix provided by the Registered Manager. This states eight of the fourteen staff employed at the home hold a National Vocational Qualification (NVQ), eleven staff have received training in diabetes, two on the Mental Capacity Act, two wound care and four dementia awareness. Care Homes for Older People Page 22 of 29 Evidence: We examined the recruitment records of the two newest members of staff to commence work at the home to assess if practices safeguard residents. Both contained an application form, two references and evidence of an Enhanced Criminal Records Bureau (CRB) disclosure. The application form for one of the members of staff had not been completed in full and information regarding the CRB did not include the date it was obtained. The Registered Manager informed us CRB information used to be maintained in the home until the home was purchased by its current owners, who now store this information centrally. We explained that if the organisation wishes to maintain recruitment information centrally this must be agreed in writing with the commission and certain information including the date of issue maintained in the home. This information is needed in order that the home can evidence staff CRB disclosures are obtained prior to them commencing work and so offering safeguards to residents. The Registered Manager produced a document titled practical steps for new staff members and volunteers. She explained that this is going to be given to all new staff to assist with their induction. The contents of this give information on fire procedures, waste handling, lifting loads, health and safety, security, smoking and the use of mobile phones. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff have confidence in the managers approach to running the home and feel that the home is run in their best interests. Quality monitoring systems are in place to ensure that the views of residents and other interested parties are sought. These allow the home to measure how successful it is at meeting its aims and objectives. Systems for handling residents monies ensure their financial interests are safeguarded. The home provides a safe environment for residents. Evidence: As at previous inspections residents and staff spoken with all spoke highly of the Registered Manager and her approach to running the home. The Registered Manager has completed the Registered Managers Award and has over two years experience as manager of the home. When we arrived at the home to undertake our inspection the Registered Manager informed us she has resigned from her position and will no longer be in post from the following Monday. The Registered Care Homes for Older People Page 24 of 29 Evidence: Manager confirmed she had not notified us in writing of her intended resignation. She informed us that the company that owns the home have been interviewing potential candidates to replace her. Later during our visit the Registered Manager informed us that a new manager has been appointed who would be commencing either in December or January. We were informed that the deputy will manage the home until the new manager starts with support from the organisation that owns the home. The registered manager informed us that questionnaires have been completed by residents, families and visitors to the home and that these are currently being analyzed. We viewed an action plan that forms part of the homes quality monitoring systems. The Registered Manager explained that the action points contained with this are generated from the monthly visits undertaken by representatives of the organisation that owns the home. Before out visit the the home the Registered Manager sent us the homes Annual Quality Assurance Assessment (AQAA) as instructed. Parts of this do not contain sufficient information to evidence how key National Minimum Standards are met. We discussed this with the Registered Manager during our visit to the home who agreed to pass this information on to representatives of the organisation. We sampled the financial records and personal monies of two residents, finding both to be in good order and up to date. The training matrix we viewed details fourteen staff, thirteen who have received training in moving and handling, eleven in food hygiene, six infection control and four first aid. No health and safety matters relating to the environment came to our attention during this visit to the home. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 In line with Regulation 12 (1)(a)(b) improvements must be made to the management of diabetes. This must include ensuring consistent monitoring of blood sugar levels and improving staffs understanding of safe blood sugar levels. This must happen so that residents health needs are met safely. 22/12/2008 2 29 19 A record must be maintained 23/01/2009 in the home of the date when CRB disclosures have been obtained, the level of disclosure and this must be signed as accurate by either the Registered Manager or Registered Individual. If recruitment records are to be stored away from the home, written agreement must be obtained with CSCI and information maintained Care Homes for Older People Page 27 of 29 as detailed in CSCI CRB policy guidance issued October 2008. This must happen in order that the home can evidence its recruitment practices safeguard residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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