CARE HOMES FOR OLDER PEOPLE
The Arches Residential Home Mounts Road Greenhithe Kent DA9 9ND Lead Inspector
Ruth Burnham Key Unannounced Inspection 14th February 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 The Arches Residential Home DS0000024030.V327958.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. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Arches Residential Home Address Mounts Road Greenhithe Kent DA9 9ND 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) 01322 370163 01322 381642 archeshome@yahoo.co.uk Arches Care Home Limited Mrs Joy Chapman Care Home 21 Category(ies) of Dementia - over 65 years of age (21) registration, with number of places The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Only 18 beds can be used as Dementia Care beds until new extension is built and then the number can increase to 21. 28th November 2006 Date of last inspection Brief Description of the Service: The Arches is currently registered to accommodate 18 older persons who have been diagnosed with dementia. There is a large lounge/dining room on the first floor and smaller lounge diner on the lower ground floor, the home also benefits from a large conservatory with extensive views over the valley. There is a small garden to the rear. The home is on 3 floors; there is a 5-person lift to all floors. The owner employs a registered manager and deputy manager who lead a team of carers including 2 carers who work at night on waking duty. A cook, an activities coordinator and a cleaner are also employed. The home is situated in a quiet residential area of Greenhithe with local shops and post office close by. Bluewater shopping complex is approximately 2 miles away. Fees charged range from £400 to £420 per week. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report reflects the findings of a random inspection and a key inspection of the home. The random inspection was carried out in November 2006. Two inspectors who were in the home from 10:00 to 15: 30 for the site visit on 28 November. The site visit on 14 February 2007 took place between 08:30 and 15:30 and was undertaken by an inspector and a regulation manager. Before the second site visit service users, relatives and health and social care professionals were written to asking them to comment on their experience of the home, at the time of writing this report 3 written responses had been received from relatives of people living in the home, all of which were positive. None of the correspondents had had to make a complaint. The Social Services Department of Kent County Council have carried out an adult protection investigation following a serious incident, which occurred at the home. This investigation was concluded in August 2006, recommendations made as a result of the investigation have been implemented by the home. During the visits a number of documents and records were examined, discussion took place with the owner and the manager, some staff and service users were spoken with, however, given that all the people who live in the home have dementia, a proportion of the visits was spent directly observing the care and interaction between staff and residents and case tracking through care plans and other records. A tour of the premises was also carried out. What the service does well: What has improved since the last inspection?
An extension has been added to the home to provide 5 additional bedrooms, these have en suite toilet facilities and will provide comfortable accommodation for future occupants. It was stated that existing residents would have the opportunity to move into these new bedrooms should they wish. All the people who live in the home have single bedrooms. An up to date statement of purpose and service user guide is provided for people who are considering moving into the home. This also provides information for those already living there. People who live in the home have been provided with revised contracts. The assessment of the residents’ needs is now updated monthly.
The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 6 The conflict of interest where the owner and GP are the same person has been mitigated through a transparent policy whereby all parties are informed of this. People who live in the home are protected through safe systems of medication storage and administration in compliance with recognised guidelines. The routines of daily living and activities have been improved through the recruitment of an activities co-ordinator. Choice and opportunity to have involvement with decision-making processes is now offered in a way that service users can comprehend. Food is offered and prepared in a way, which takes account of the nutritional needs of older people with dementia. Staff have been given a clear complaints procedure and have been told they may contact the Commission about any concerns they may have which are not being addressed. Plans to make the garden safe and accessible are in place with work due to start once weather permits. Advice has been sought from appropriate professionals who specialise in elderly and dementia care in order for improvements and adaptations to be made to the home in line with the home’s stated aims and objectives. Work is ongoing to comply with all their recommendations. Suitable arrangements are being made for maintaining satisfactory standards of hygiene in the care home in the kitchen so that food storage and handling will comply with the requirements of the Food Safety Act. Improvements have been made in staff training to ensure that there are sufficient, suitably qualified and competent staff on duty at all times to meet the needs of the residents. An approved induction training programme has been introduced for new staff. Good recruitment procedures and effective supervision of staff are in place to protect residents from harm. The manager and the owner are working together to ensure that the home is run in the best interests of the people who live there. Work has begun to implement a quality assurance system to ensure that shortfalls are identified and improvements are carried out as required. Compliance with the majority of the requirements made following the inspection in May 2006 has been achieved. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 7 What they could do better: 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. The Arches Residential Home DS0000024030.V327958.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 The Arches Residential Home DS0000024030.V327958.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): 1–6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are considering moving to the home are provided with accurate information upon which to base a judgment. Good admission procedures ensure that their particular needs are identified and can be met. EVIDENCE: People who are thinking about moving into the home or moving a relative into the home are provided with information about what life is like there. The information is contained within the Statement of Purpose and the Service User Guide, these documents have been revised and updated in the past year. Records relating to the admission and care of new residents were examined. The information is detailed and will help staff and management plan the care of new residents in order to best meet their needs. Wherever possible, the assessment is made when visiting the prospective residents in their own home prior to admission.
The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 10 People who live in the home are provided with a contract. The contract has been updated since the last inspection and is signed by all parties. The Arches Residential Home DS0000024030.V327958.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 – 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home are adequately cared for, all their healthcare needs are met and they are benefiting from improvements made since the last inspection. However they may be at risk of harm where risks associated with changing needs are not clearly identified or incorporated into an up to date care plan. EVIDENCE: People who live in the home are benefiting from improvements made since the last inspection. Care plans were sampled which showed good initial assessment of the residents’ care needs. The management have worked hard to make sure that plans are now being reviewed monthly however the content of these reviews is still not being incorporated into the care plan, and risk assessments are not always being updated to reflect any changes identified in the reviews. This means that staff may not have access to the most up to date information about how to care for people who live in the home or minimise any risk to them. The manager is reviewing every care plan to ensure that staff have clear
The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 12 guidance about how to continue to meet each resident’s changing needs in a way which reflects their individual wishes and protects them from harm. A number of people who live in the home still have the same GP, Dr Desai, who is also the owner of the home. It remains the view of the Commission that, carrying out this duel role as the service users’ Doctor and owner of the home could lead to a possible conflict of interest. To show openness and transparency and to comply with the guidance issued by the General Medical Council, relatives and placing authorities have all been informed in writing by the home of the current situation and all residents have a choice of GP. People who live in the home have their healthcare needs met. In the files sampled there were examples seen of health care needs of people who live in the home being identified and followed up by staff. The plans of care include details of the dietary needs of the residents. The cook has had training in the specific nutritional needs of the elderly. People who live in the home are provided with access to a chiropodist, dentist and optician when required. The home encourages the family to go to hospital appointments with their relative. An escort from the home can be arranged for a fee. The manager explained that they do try to offer a home for life but they are not a nursing home so if the service users develop an ongoing nursing need then an alternative home would have to be found. People who live in the home are protected through safe handling of medication policies and procedures. Medication is mainly stored in a small drug trolley which holds the monitored dosage system packs, creams, additional medication and records. The trolley is secured to the wall in a sectioned off area adjacent to residents’ rooms. The medication administration records include the amount of medication received and that carried over. Only trained staff administer medication. Controlled medication was properly signed for and stored safely. There is a list of staff signatures with their initials. The Arches Residential Home DS0000024030.V327958.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 – 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home are helped to make choices and exercise control over their own lives. They benefit from opportunity to take part in a range of recreational activities. EVIDENCE: The quality of life for people who live in the home has improved through the increased and planned provision of recreational activities. An activities coordinator has been recruited for 3 days each week. People who live in the home have some opportunity for trips out into the community. The home has church services that are held monthly. Visitors are made to feel welcome and can visit at any reasonable time. People who live in the home are benefiting from improvements that have been made since the last inspection around how choices are presented. This is particularly evident at mealtimes. The dining rooms are pleasant and have been made to look homely. The cook is qualified and has training in the specialist nutritional needs of the elderly and specifically those suffering from dementia. Meals are served in a way that presents choice to people who live in the home in a way they are able to understand.
The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 – 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home are protected from abuse. EVIDENCE: People who live in the home are provided with a complaints procedure. The manager said no complaints have been received therefore no record was available for inspection. People who live in the home are protected from abuse through good recruitment practice. All staff have been checked through the Criminal Records Bureau before working in the home. A serious incident occurred in the early part of 2006, this resulted in an adult protection investigation led by the Kent County Council Social Services Department. The home has implemented all the recommendations made following the investigation, the member of staff involved has been dismissed and the investigation is now concluded. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 – 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from the good standard of cleanliness and homeliness of the environment. The provider and manager are in the process of making improvements to the premises which will enhance the lives of residents once the work is completed. EVIDENCE: People who live in the home are benefiting from improvements which are being made to the home. Communal areas are generally pleasant and homely. There is a good standard of cleanliness throughout the property. Service Users have a choice of lounges situated on two floors. There are ramps and handrails around the home. There is an emergency call system throughout the home. There are 2 baths with hoists, a shower room which is suitable for people with reduced mobility and there are 5 WC`S.
The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 16 A new extension has been added to the home which provides an additional 5 bedrooms with en suite w.c. and hand basin. Bedrooms in the older part of the property only have hand basins. The new bedrooms are well decorated and furnished and will provide a comfortable environment for the occupants. A specialist in the care of people with dementia has inspected the premises and produced a report with recommendations of how the home can be made more user friendly for people with dementia. Many of the recommendations have been implemented and work is ongoing to complete all the work. It has been agreed by the Commission that the new bedrooms are fit for use. Many of the people who live in the home have personalised their rooms with their own pictures and ornaments and small items of furniture. People who live in the home all benefit from single rooms, there are now no shared bedrooms remaining in the home. Some bedrooms in the older part of the property would benefit from refurbishment. The owner confirmed that a landscape gardener has been contracted to reinstate and improve the garden now that building work is finished. This will take place as soon as weather permits. Plans for this work take account of the needs of the people who live in the home and include features to ensure the garden is accessible to people who have mobility difficulties. The laundry is small and in need of improvement. The owner said there are plans to increase the size of the laundry to ensure that clean and dirty areas can be kept separate to minimise the risk of cross infection, as yet there are no timescales for completion of this work. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 17 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 – 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home are supported by a committed and caring staff team whose skills are improving through increased training opportunities. EVIDENCE: People who live in the home are supported by a caring and committed staff team. There are sufficient staff at the present time to meet the needs of residents. It is planned that the number of residents will increase to 21 in the near future now that the extension is finished and additional bedrooms are available. It has been agreed that an additional member of staff will be recruited before there is any increase in current numbers. It was also agreed that the manager will undertake a review of staffing levels against currently accepted guidelines. This review will take account of the difficulties that the layout of the accommodation poses in providing care to people who are suffering from dementia. The accommodation is arranged over three floors with most service users being on two floors during the daytime hours. Bedrooms are located on all three floors and there is some risk that residents may not be adequately supervised at night although there are 2 waking night staff. Ways of improving monitoring of residents at night were discussed including the use of electronic alert systems. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 18 People who live in the home are protected through sound recruitment systems. Staff files sampled at this visit and during the last inspection in November 2006 were found to contain an appropriate application form, interview notes, proof of a satisfactory Criminal Records Bureau check, photographs, references and employment contract. The manager said that new staff are now following an approved induction training programme. It was encouraging to talk to staff and find that morale has improved, the atmosphere in the home is pleasant, calm and relaxed which must clearly have a positive affect on the lives of the people who live in the home. Staff training has improved and the majority of staff have now received specialist training in caring for people with dementia, People who live in the home are protected through the improvement in access to training in basic food hygiene, adult protection and infection control. Staff have undertaken fire safety training and moving and handling. Some discussion took place about the need to provide training for staff in specific specialist needs such as Parkinsons disease to ensure that individual needs are understood and met. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The safety and quality of life of people who live in the home is being improved through the introduction of a quality assurance system and through the hard work that the provider and management team have put in to meet requirements made at previous inspections. EVIDENCE: People who live in the home benefit from a strong and committed management team. The registered manager at the home has many years experience working in the caring industry, starting off in nursing and then becoming a social worker, having gained a social work qualification. The manager also has completed a diploma in management. As the manager is nearing retirement
The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 20 she has now chosen not to undertake the required Registered Manager’s Award but is supported by a well qualified deputy manager. People who live in the home are benefiting from the improvement in the atmosphere and staff morale. The provider and management team have worked very hard to meet the requirements that were made following the inspection in May 2006. They are to be congratulated on achieving compliance with the majority of these. There is still some concern that Residents may be adversely affected by the ineffective working relationship between the owner and manager although this has clearly improved since the last inspection. The management team have begun to set up a quality assurance system in the home, a number of quality monitoring forms have been introduced and surveys have been sent out to residents and relatives. Some discussion took place about how to progress this further in line with the requirements of the regulations. This will ensure that current improvements are sustained and the quality of life for people who live in the home is constantly improved. People who live in the home are now better protected through improved staff training and supervision. Staff now receive regular formal supervision, they have regular appraisals. Training in safe working practices is being provided for staff and further training is planned. Some lapses in good infection control practice were noted during the inspection which were immediately brought to the attention of the manager. The Environmental Health Officer has inspected the home recently; some recommendations in relation to food storage were made following their visit. The manager is in the process of implementing those recommendations. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 2 3 2 3 2 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x 3 2 3 2 The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation Requirement Timescale for action 30/03/07 15 (2) The registered person shall 13 (4)( c ) keep the service users plan under review; where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service users plan; and notify the service user of any such revision. In that care plans must be updated as needs change to provide clear guidance to staff on how to meet the care needs. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, in that Risk assessments must be updated as part of the care plan The previous timescale for action on this requirement was 30/6/06, this timescale has been extended to allow the manager to complete all the work necessary. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 23 2. OP33 24 The registered person shall establish and maintain a system for reviewing at appropriate intervals; and improving the quality of care provided at the care home. The registered person shall supply to the Commission a report in respect of any review conducted by him and make a copy of the report available to service users. The system referred to in paragraph (1) shall provide for consultation with service users and their representatives. 30/04/07 3 OP38 13(3) The timescale for compliance with this requirement following the inspection in May 2006 has been extended as work is progressing towards achieving compliance. The registered person shall make 28/02/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. On that all staff must be trained in infection control, no communal toiletries must be left in bathrooms and contaminated material must be kept separate and away from clean areas. Staff must follow safe procedures in that protective clothing must be changed and disposed of safely between tasks. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 24 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 OP23 OP25 2 OP30 Refer to Standard Good Practice Recommendations That the provider continues to improve the existing environment by redecoration and refurbishment. The home should meet the needs of older people with dementia. Staff should be trained in subjects to meet the needs of existing residents. The Arches Residential Home DS0000024030.V327958.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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