CARE HOMES FOR OLDER PEOPLE
Southdown Nursing Home 5 Dorset Road Cheam Surrey SM2 6JA Lead Inspector
Alison Ford Key Unannounced Inspection 31st May 2007 10:30 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 Southdown Nursing Home DS0000019123.V339785.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. Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Southdown Nursing Home Address 5 Dorset Road Cheam Surrey SM2 6JA 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) 020 8643 1639 020 8642 1369 Mr Wijayarathna Mrs Melba Rosario Wijayarathna Post vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (0) of places Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of service users admitted with a diagnosis of dementia does not exceed 10. A Registered Mental Health Nurse or Registered General Nurse who holds a recognised Dementia training certificate is always on duty. All staff must have dementia awareness training. Date of last inspection 6th February 2007 Brief Description of the Service: Southdown is a converted and extended house, registered with The Commission For Social Care Inspection to provide nursing care for up to 25 elderly people, including up to ten that may suffer from dementia. The home is situated in a residential area of Cheam and is close to public transport links. There are fifteen single and five double rooms accommodated on two floors. Nine of the single rooms have en-suite facilities. A shaft lift provides access to the lower first floor with a stair lift serving those few bedrooms on the upper first floor. In addition to the dining room there are two communal lounges. There is pleasant back garden, which can be used by residents, and car parking is available at the front. At the time of this inspection fees range from £490 - £540 per week. Any additional charges that might be payable for personal items or services such as hairdressing would be discussed prior to admission. Copies of the homes Statement of Purpose and the latest inspection report can be obtained directly from the home or, in the case of the latter, from the Commission for Social Care Inspection via the internet. Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first visit as part of the inspection process for the year 2006/2007 and was unannounced. In compiling this report consideration has also been given to other information received during the inspection year such as comments complaints and notifications. A partial tour of the premises was undertaken and a sample of care plans, records and documentation relating to the health and safety of residents was seen. There were twenty-one residents living in the home although one was in hospital, and several were spoken with, also three of the members of staff on duty at the time and three relatives who were visiting. The home is currently without a Registered Manager although The Commission is currently processing an application for this role. The inspection was undertaken with The Registered Provider, her son and a senior member of the nursing team. They were all receptive to the inspection process and are thanked for their help. No complaints have been received about this service since the last inspection. What the service does well:
The residents in this home and their families consider that they live in a pleasant environment, which suits their needs, and all of those that were able to express an opinion, were appreciative of the care that they receive. Residents looked well cared for and comfortable and comments were made that “its nice living here ” “ staff treat us well ” and that “food is lovely here” Relatives that were spoken with generally agreed that residents were always well cared for and they had no concerns. Menus were varied and particular preferences and dietary needs are catered for. Staffing levels appear to be sufficient to meet the care needs of residents and many of the staff have received some training in caring for residents with dementia. Staff turnover is very low, enabling continuity of care to be provided and more than 50 of carers are educated to NVQ level 2 and above. Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 6 A comprehensive pre-admission assessment in addition to the one from the care manager ensures that the healthcare needs of residents will be met and care plans accurately reflect the care that is currently being delivered. These plans are regularly reviewed and advice is gained from other healthcare professionals as required. Their frailty means that residents are often not able to contribute to these plans however input is encouraged from their relatives who sign to say that they agree with them. Some activities, suitable for the needs of the residents, are provided and recognising the importance of any form of interaction and communication with residents the range of these is being increased. What has improved since the last inspection? What they could do better:
In order to make sure that residents and their families have all of the information that they need about the home, the Service User Guide needs to be developed. This becomes a useful reference tool or “guide to the home” and must be available to all of the people who use the service. Although care plans are generally good, there is no evidence that residents or their relatives have been asked about their wishes in the event of them becoming unwell or their death. Although it is sometimes difficult to address
Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 7 this issue the information is important so that staff are all aware of the correct procedures to follow. There are currently some people who use this service for whom English is not their first language and others are very confused. It was recommended that alternative methods of communication should be developed using pictures and symbols. Some of the home would still benefit from redecoration and refurbishment and there must be an ongoing programme in place so that the home remains a pleasant and suitable environment for the people who live there. While it is acknowledged that work is being undertaken to improve the home and the outcomes for the people who live there the overall rating is influenced by some concerns about the health and safety of the residents. On the day of the inspection the front door had been left open with the risk that residents could have wandered out of the home. It was also found that the temperature of the water in one bathroom was unacceptably hot. Although immediate steps were taken to protect residents from going in to the bathroom and scalding themselves it highlighted the fact that not all water temperatures are always checked routinely. These issues will be able to be easily addressed to help ensure the protection of those living in the home. 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. Southdown Nursing Home DS0000019123.V339785.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 Southdown Nursing Home DS0000019123.V339785.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): Standards 1,3,6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who use this service can expect that a pre admission assessment will be carried out to ensure that the home and the services that it provides will meet their assessed needs. Although some written information is available to them, the Service User Guide needs updating so that they are aware of all of the services that the home will provide for them and they can decide if it will suit them. This home does not offer intermediate care. EVIDENCE: The local authority funds the majority of the current residents and the care manager’s assessments, determining the level of support that is required were seen in care plans that were assessed. In addition a senior member of the
Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 10 homes staff will visit a potential resident to make certain that their needs can be met. In response to a requirement issued at the last inspection, a new Statement Of Purpose has been developed. This is a full and comprehensive document, which meets the requirements of the regulations and provides a detailed explanation as to how the people who use the service will be supported and cared for. A Service User Guide has been developed however, this still needs further work to make it a useful reference tool for residents and their relatives and provide all of the necessary information. A copy of this must be made available to all of the residents in the home and it is suggested that it should be left in their bedrooms for them to refer to. Southdown Nursing Home DS0000019123.V339785.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): Standards 7,8,9,10 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The people who use this service consider that they are always treated with respect and dignity. Their care plans accurately reflect their assessed healthcare needs and appropriate interventions and support are given to ensure that these are met in the way which they prefer. Medication policies and procedures are in place to ensure their protection. EVIDENCE: A sample of five care plans was inspected at this inspection. These are reviewed monthly to ensure that they reflect the care that is currently being provided and relatives are invited to participate in the process. Input is gained from other healthcare professionals as required. There was evidence that many of the problems that might be associated with this client group have been considered and appropriate interventions put in place.
Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 12 Residents and their relatives that were spoken with consider that outcomes for them with regard to their personal care are good. They are supported in the way that they wish and their views are taken into account. There must still be some information included in care plans about residents and their representative’s preferences in the event of them becoming unwell or their death and evidence that this has been discussed. The lack if this could mean that staff are not aware of the residents preferred wishes. Residents are weighed monthly however, it was noted that some residents have lost weight while in the home and there is no indication that any steps are taken to identify reasons for this loss and how it may be managed. There must be evidence that this is being recognised and managed appropriately. Since the last inspection more work has been undertaken to produce “life histories” of residents outlining their previous lives and achievements. This has allowed staff to gain a better understanding of the people that they are caring for. Two of the residents in the home have a limited ability to speak English and it is recommended that additional methods of communication should be explored with them such as pictures. Staff were observed treating residents with respect and all the residents spoken with agreed that they were always kind. Personal care is delivered in resident’s own rooms and screening is provided in shared rooms. Medication records and storage were in order although care must be taken to ensure that external preparations are disposed of when residents are deceased. Southdown Nursing Home DS0000019123.V339785.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): Standards 12,13,14,15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who use this service are encouraged to make choices within their limitations in order to preserve their independence, and their visitors are encouraged so they maintain relationships with families and friends. Meals that are served in the home are nutritious and suited to resident’s preferences, and a limited range of activities in the home offer them stimulation and interest. EVIDENCE: The majority of residents in this home are very frail and have limited capabilities although they are encouraged to make choices in their lives as much as they are able. Some of them have chosen to get up later in the morning and a newly admitted resident in the home explained that someone had taken time to ask them about how they wished to spend their time. Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 14 Visitors are always made welcome and three of them who were visiting at the time were spoken with and all of them commented on the friendliness and kindness of the staff. The lunchtime meal was served during the inspection and looked well cooked and presented. Those who were able to express an opinion confirmed their satisfaction with the food served in the home, menus were varied and choices are available. The menus are currently being revised to suit resident’s preferences. These will then be displayed in the dining room. In view of the limited abilities of many of the residents and the fact that for two of them English is not their first language it was recommended that the home should explore the possibility of introducing picture menus. The available meal choices should also be indicated on the menus. A range of activities is offered in the home and this has been expanded since the last inspection. It was recommended that some of the staff who might be interested might like to undertake some additional training in order to improve the activities programme. Southdown Nursing Home DS0000019123.V339785.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): Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use this service have access to an appropriate complaints procedure, which should ensure that their concerns would be listened to, and acted upon promptly. They are confident that measures are in place to protect them from abuse. EVIDENCE: There is a complaints procedure, which is displayed in the hall. This provides information about the process and all of those relatives that were visiting confirmed that in their opinion the management team would always deal with any concerns promptly. The complaints book was seen and there were two documented concerns that had been dealt with appropriately. In order to help to protect residents no new members of staff are employed without appropriate clearance from the Criminal Records Bureau and all of them have received training in the recognition of adult abuse within the last year.
Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 16 Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 17 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): Standards 19,26 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The people who use this service consider that they live in a home, which suits their needs and expectations, although there must be an ongoing refurbishment programme in place so that it remains a pleasant place for them to live in. EVIDENCE: A partial tour of the premises was undertaken. It was noted that although several bedrooms have been decorated some of the furniture is mismatched and would benefit from replacement. The bathrooms would also benefit from upgrading so that bathing is always a pleasurable experience for residents. An ongoing redecoration and refurbishment programme must be put into place to ensure that the home is always a pleasant place to live in. Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 18 It was also noted that several areas of the home were malodorous although this had not been an issue at previous visits. The front door had been left open to try and alleviate this however this could potentially pose a serious hazard for residents and must not happen in the future. A requirement to keep this locked is issued under standard 38. There was a concern regarding very hot water in one bathroom however this was dealt with promptly, residents were prevented from using the bathroom and an engineer was called. It highlighted the fact that water temperatures are not checked regularly in that bathroom; this must be done on a weekly basis to ensure that temperatures remain around 43 degrees Celsius. Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 19 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): Standards 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. People who use this service are cared for by sufficient staff to meet their healthcare needs and pre-employment checks are generally undertaken which ensure their protection. Training is in place to help staff to fulfil the aims of the home and meet the needs of the residents. EVIDENCE: On the day of the inspection there were sufficient numbers of staff on duty to care for the twenty residents currently living there. Off duty records confirmed this to always be the case. The majority of the care staff have completed an NVQ level 2 qualification and one is currently undertaking level 3. In addition to mandatory training, all of the staff have undertaken training in dementia awareness. Other recent topics have included peg feeding and first aid. Only one new member of staff had been employed since the last inspection. There was evidence of clearance from the Criminal Records Bureau however other records required to be obtained prior to employment were not available.
Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 20 An assurance was given that these had been obtained and were being held elsewhere however these must be available in the home for inspection. Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 21 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): Standards 31,33,35,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people who use this service cannot feel confident that their health and safety is always protected and that they will be free from harm. The home is currently not being managed by a person who has provided evidence of their abilities however systems are currently being developed to allow residents to influence the way that the home is run. EVIDENCE: The home is still without a Registered Manager although The Commission is currently processing an application for this role. A quality assurance system is being developed within the home to gain the views of residents and their relatives in order to influence the way that services are delivered. There are quarterly meetings held and a newsletter is
Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 22 distributed following the meeting discussing the topics that were spoken about. It was considered that this was a very positive step towards allowing residents and their families to comment on the home and the care being provided. A questionnaire has been developed and this will be distributed on a regular basis to try and gain the views of those using the service and staff meetings are held regularly so that everyone is made aware of the latest developments. No money is currently held on behalf of any residents; a relative or representative deals with their financial affairs. Supervision of staff is being developed to monitor performance and identify future training needs. To date this has been undertaken intermittently and must be increased to every two months. Although there are very few accidents reported within the home, some concerns were raised about safe working practices. Kitchen records were not always filled in appropriately and the door and windows in there were wide open. If these are to be open a fly screen or insect killer must be installed. Alternatively a fan should be fitted in the kitchen. As noted in standard 19 the front door had been left open meaning residents could possibly have wandered out into the road. This must be kept locked at all times. Hot water temperatures in the upstairs bathroom were unacceptably high although this was addressed at the time however it identified the fact that the water temperatures in this bathroom were not monitored on a regular basis. Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 1 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 X 1 Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 5 Requirement The Service User Guide must be developed to provide a useful reference tool for residents and their families and a copy must be made available to every person using the service. Care plans must contain evidence that people who use this service have been consulted about their wishes in the event of them becoming unwell or their death so that everyone is aware of the procedures to be followed. There must be evidence to show that any unexplained weight loss in residents has been noted and a plan as to how it is managed is put in place if necessary. There must be an ongoing redecoration and refurbishment plan in place to ensure that residents are able to live in a pleasant environment, which suits their needs. There must be a plan in place to indicate when bathrooms will be upgraded and refurbished to make sure that bathing is a pleasurable experience for the
DS0000019123.V339785.R01.S.doc Timescale for action 30/09/07 2. OP8 15 30/09/07 3. OP8 15 30/09/07 4 OP19 23(2)(d) 30/09/07 5 OP26 23(2)(d) 30/09/07 Southdown Nursing Home Version 5.2 Page 25 6 OP26 23(2)(d) 7 OP26 13(4)(a) 8 OP29 Schedule 4 (6) 18(2) 9 OP36 people living in the home. The home must be kept free from malodour to make it a pleasant place to live in and to visit. There must be evidence that hot water temperatures are being monitored on a weekly basis to minimise the risk of people who use this service scalding themselves. All of the necessary records relating to the employment of staff must be available for inspection. All care staff have must have formal supervision sessions at least six times a year in order to monitor their performance and identify any training needs. (Previous timescale 08/11/06, 30/05/07 not achieved) 31/05/07 31/05/07 31/05/07 30/09/07 10 OP38 13(4)(c) 11 OP38 13(4)(c) 12 OP38 13(4)(c) All kitchen records must be kept 31/05/07 up to date as evidence that necessary checks are being carried out. A fly screen or insect killer must 30/09/07 be put into the kitchen to reduce the possibility of contamination of food. The front door of the home must 31/05/07 be kept locked to ensure that residents do not leave unnoticed. Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 26 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. Refer to Standard OP8 OP15 OP15 Good Practice Recommendations It is recommended that additional forms of communication should be explored for those residents for whom English is not their first language. It is recommended that a member of staff should be able to access further training regarding the provision of suitable activities It is recommended that consideration should be given to the introduction of picture menus. Southdown Nursing Home DS0000019123.V339785.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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