CARE HOMES FOR OLDER PEOPLE
Tremethick House Meadowside Redruth Cornwall TR15 3AL Lead Inspector
Paul Freeman Announced Inspection 16th January 2006 10:00 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 Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 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. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Tremethick House Address Meadowside Redruth Cornwall TR15 3AL 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) 01209 215713 01209 215713 Mrs Mary Allison Anson Mr John Robert Anson Mrs Barbara Denise Ball Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th July 2005 Brief Description of the Service: The home is owned and run by Mr and Mrs Anson and the providers take an active role in the services and facilities provided. A registered manager Mrs Denise Ball has been appointed to take the lead role in the day to day running of the home. Tremethick is a care home that offers care to twenty-eight older people. The majority of bedrooms are for single occupancy and communal space is provided throughout the home. The majority of the communal space is located on the ground floor and is maintained to a high standard. There is reasonable access outside and inside the home for people who experience a disability. A passenger lift is also provided. The home is located on the edge of Redruth town with pleasant grounds and good car parking facility. The location provides easy access to the town, leisure facilities and health services. The home offers transport to appointments and for outings. The home state they provide care in a manner that meets the individual needs and preferences of residents in a manner that promotes independence, dignity and the rights. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A planned announced inspection took place on 16 January 2006. The purpose of the inspection was to consider the work that had been undertaken on the requirements and recommendation set at the last inspection on 18 July 2005. In addition some of the key standards were considered which included assessment and care planning, health and safety and staffing arrangements. One of the registered providers Mrs Anson and the registered manager, residents and staff were consulted about the services and facilities provided. The environment, records and documents were also considered. Prior to the inspection the providers sent to the Commission written information about the care homes operation. Written comments were also received from one relative. The requirements and recommendations set at the last inspection had been worked upon and the registered provider, registered manager, staff and residents fully cooperated and were very helpful throughout the inspection period. What the service does well:
Each prospective resident is visited before they move to the home for the providers to undertake an assessment of their needs and to determine their individual choices and preferences. The views of the prospective residents relatives or representatives are also taken into account. The Providers will also consult with any speaclist workers that are involved with the prospective resident at that time. Residents that had recently moved to the home said they had been fully consulted before their move and were very satisfied with the care and support they receive. A dedicated interim care or rehabilitation service is not provided. However every reasonable step is taken to make sure that residents are able to be as independent as possible. Residents commented they are well looked after and are confidant their health needs are well provided for. The records show that health professionals regularly visit the home and that services are efficiently accessed when required. Suitable records of each visit are made and this makes sure the staff has an up to date picture of the residents needs. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 6 Prescribed medicines are appropriately managed in a safe manner and a suitable policy and procedure has been established about the arrangements in place. Residents are able to administer their own medicines where it is safe to do so. Where the providers assist a resident with their medication the staff concerned has been suitably trained and good records are maintained. Residents state they are very satisfied with the lifestyle they experience at the home. A range of activities is provided at the home and in the local for residents to participate if they wish. Many of the residents prefer to arrange their own leisure time and the residents said they felt in control of their lives. Residents were very complimentary about the food. One resident described the food as “excellent” another said, “we have good food and we could not expect anything more.” A seasonally adjusted menu is in place that takes account of the residents’ preferences and choices. Residents are also provided with a choice at each meal and were more than satisfied about the quantity and quality of food they receive. Plans are at the final stage of development to refurbished, improve and upgrade the kitchen area. This will be achieved by a purpose built extension at the rear of the property. The current kitchen equipment meets the required standard and is regularly maintained and serviced. Appropriate standards of hygiene and cleanliness are maintained and satisfactory measures are in place to promote a safe and healthy environment. The providers or the Commission over the last year has received no formal complaints. Positive arrangements are in place to deal with any complaints or concerns that arise. Residents said they had confidence about raising any issues and were sure the matter would be dealt with promptly and resolved in a satisfactory manner. Satisfactory arrangements are also in place to protect residents against abuse. Any allegations or issues or concerns are reported and a formal investigation occurs. Suitable whistle blowing arrangements are in place and staff are able to report any concerns to a third party if they are unable to approach the providers. This provides residents with further protection measures. A good standard of cleanliness and hygiene is maintained at the home and residents said they were very satisfied with the arrangements in place. Sufficient numbers of staff are on duty each day and night and additional staff are provided when this is required to meet the needs of residents. The staff are well trained and have a wide range of skills and experience. Resident’s
Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 7 commented they were very satisfied with the manner in which staffs undertake their duties. The residents said that staff were flexible, reliable and available when they require care or assistance. The residents were also very complimentary about the relaxed atmosphere of the home and the positive attitude the staff have towards their work. Some of the residents said “wonderful service,” you only have to ask and staff will accommodate,” and “nothing is to much.” The home is well run and managed for the benefit of the residents. The manager takes the lead in the day to day running of the home and the providers also play an active role in the services and facilities provided. Residents said the providers and manager are very approachable and there are no barriers to raising any issues or concerns. Residents were confidant that any issues raised would be dealt with positively and efficiently. There are no concerns about the financial viability of the home and arrangements are in place to make sure that residents’ financial interests are safeguarded. The providers have established a range of policies and procedures to promote safe working practices for the residents and staff. Equipment and services are also regularly monitored and maintained. What has improved since the last inspection?
The records of the assessment that are completed for prospective residents have improved and provide sufficient detail for the providers to determine if they are able to meet the persons needs. In certain instances where resident experiences more complex needs or are not able to direct their own care it would be beneficial to provide more detail. This will make sure that detailed information is available for the care plan and to direct the care and support required. The care planning arrangements at the home continues to be improved and developed. Each resident has a care plan that outlines their needs and provides staff with the information, guidance and direction needed to provide the care and support required. In certain instances the care plans would also benefit from more information about the needs, preferences and choices of each resident. This will make sure that all staff are fully aware of the care and support required by the person concerned. The care plans are regularly reviewed with the residents and their relatives or representatives. The records of the review could be improved if more detail
Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 8 was provided. This will also make sure the staff has an up to date picture of the care and support needed. Satisfactory arrangements are in place to manage risks that may occur around the environment or with equipment at the home. The arrangements to manage risks individual residents may experience continue to improve. A risk assessment is completed when any situation arises that may compromise the health, safety or welfare of a residents or staff member. Where necessary written guidance is then established to make sure that every reasonable step is taken minimise any unreasonable risks. In certain instances the written information would benefit from more detail to provide staff with clear direction about the action required. 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. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 9 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 Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. The admission process is well managed but the records about the assessment would benefit from more information in certain instances. This will make sure that adequate information is obtained to satisfactorily direct and inform the care and support required. EVIDENCE: The assessment arrangements have continued be improved following the requirement that was set following the inspection on 18 July 2005. The providers assess each prospective resident before they move to the home. The assessment takes account of the views and opinions of any professionals that are involved with the person concerned as well as the prospective resident and their relatives or representatives. Residents that have recently moved to the care home said they were visited and fully consulted about their needs and preferences before they moved to the home.
Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 11 A format for recording the assessment is in place to record the prospective residents views and the assessors findings. The records of the assessment summarise the assessor’s findings and in the majority of instances are sufficiently detailed to provide clear information about the needs, preferences and choices of the prospective resident. In certain instances more detailed information is required in order that the assessment can appropriately guide direct and inform the care plan and the care and support provided to the residents concerned. However sufficient information is obtained for the providers to determine if the services and facilities meet the needs of the prospective resident. The providers do not offer a intermediate care service or rehabilitation service but are committed to maintaining residents independence as far as possible. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 9 and 10. Residents are well looked after but some the care plans do not provide adequate guidance and direction for the staff to ensure that residents’ needs preferences and choices are met. Good arrangements are in place to meet resident’s health needs and services are accessed promptly when required. Medication is held securely and good records are maintained. Satisfactory arrangements are in place to administer prescribed medicines in a safe manner, which promotes the health of each resident. EVIDENCE: Each resident has a care plan that summarises the care and support they require. The residents commented they were very satisfied with the way in which their needs are met and were complimentary about the staff and the service that is provided. The residents said they felt in control of the care they receive and were confidant they could direct the care they receive. In some instances the information and guidance to staff should be more detailed about the best ways of meeting their needs, preferences and choices. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 13 The care plans are regularly reviewed with each resident and a general record of the review is made. The records could be improved further if they include the areas discussed and any agreed action that needs to be taken. There are no barriers to residents accessing their records at any time and residents and relatives said the care provided is very good. The residents commented they were also very satisfied with the manner their health needs are met. The residents are confidant that health services are obtained promptly and efficiently when they are required. The records show that health professionals regularly visit residents and are called in when required. The records of visits have improved and provide a comprehensive picture of the visits that have occurred. Residents are able to administer their medication when it is safe to do so. Where assistance is provided by the staff a suitable policy and procedure is in place and the medicines are stored in a secure facility. The staff responsible for administering medication has been suitably trained and good records are maintained. The Pharmacist safely disposes of any medicines that are no longer required. The providers have improved and developed the arrangements for distributing prescribed medicines and this occurs in a safe and reliable manner. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. Residents find the lifestyle experienced at the home meets with their expectations and preferences and feel in control of their daily lives. The meals at this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: Residents said they were very satisfied with the lifestyle they experience and felt in control of their lives. A range of activities is provided at the home and in the local community that reflect the residents’ interests and hobbies. Residents are therefore ale to participate if they wish. Each care plan also details the person’s interests and hobbies and there are no barriers to residents meeting their religious or cultural needs. Residents said they were very satisfied with the arrangements in place. The residents were also very satisfied and complimentary about the food and menu provided. The menu is seasonally varied and reflects the preferences of
Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 15 residents. A choice is provided at each mealtime and special diets are also provided where required. Residents choose where they take their meals and an attractive well maintained dinning room is provided in a conservatory at the rear of the building. One resident described the food as “excellent” another said, “we have good food and we could expect anything more.” Plans are at the final stage of development to refurbished, improve and upgrade the kitchen area. This will be achieved by a purpose built extension at the rear of the property. The current kitchen equipment meets the required standard and is regularly maintained and serviced. Appropriate standards of hygiene and cleanliness are maintained and satisfactory measures are in place to promote a safe and healthy environment. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: The providers or CSCI has received no complaints over that last year. A satisfactory policy and procedure is in place to deal with any complaints or concerns. Residents commented they had confidence in the providers dealing with any complaints or concerns in a positive and efficient manner. The residents stated there were no barriers to raising any issues or concerns with the providers. Satisfactory arrangements are also in place to protect residents against abuse and a suitable policy and procedure is in place. Any allegations of abuse are formally reported to the authorities and where appropriate are investigated. The providers have also established satisfactory whistle blowing arrangements. The staff are therefore able to report any concerns they have about abuse to a third party if they feel unable to inform the providers. This provides the residents with further protection. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The environment is maintained to a satisfactory standard but certain facilities need to be refurbished to meet the required standard. This will provide a quality environment throughout for the residents. EVIDENCE: The environment is maintained to satisfactory standard and furniture and equipment are replaced when required. There is also an ongoing programme of redecoration and some of the bedrooms have been redecorated since the last inspection on 18 July 2005. Residents commented they were very satisfied with the accommodation and facilities provided and many have personalised their bedrooms. Certain facilities at the home require improvement given they are tired and require refurbishment. The providers are in the process of finalising plans to improve these areas and plan to extend the home to accommodate more
Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 18 residents over the next year. The new plan also includes a new kitchen and additional communal and dinning areas. The residents, relatives or their representatives and staff continue to be consulted about the plans. The providers have established reliable arrangements to undertake repairs where this is required. The residents said the maintenance staff was efficient, very competent and reliable about any repairs that are required. The home is maintained to a good standard of hygiene and cleanliness and domestic staff is on duty each day. The residents said they had no concerns about the standard of hygiene which they considered were of a high standard. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. Staff morale is high resulting in an enthusiastic workforce who are well trained and work positively with residents to provide a good quality of life. EVIDENCE: Residents commented they are very satisfied with the manner in which staff undertake their duties. They said that staff was readily available, flexible and responsive to any needs or requests they have. The residents also commented on the positive attitude of the staff and the friendly atmosphere around the home. Residents were also very positive about the manner in which their dignity and respect is maintained. The records show that sufficient number of staff are on duty each day and night and were necessary additional staff are employed to make sure that residents needs are not compromised. There has been a turnover of some staff in recent months and it is evident the staff group have a wide range of skills and experience. Residents said that new staff had been positively introduced to their roles and responsibilities and had confidence in the care and support they received. A senior member of staff is on duty throughout the day to coordinate the care and support and reliable on call arrangements are in place each night.
Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 37 and 38. The home is well run and managed and the staff is well supported by the providers and manager of the home who provide clear leadership. A good standard of record keeping is maintained which enhances the services and facilities provided. The home is clean and hygienic and the risk management arrangements continue to improve to make sure that residents live in a safe setting. EVIDENCE: Residents commented the home is well run and there are no barriers to raising any issues with the providers or registered manager. The registered manager coordinates the day to day services and facilities and the providers also play an active role in the running of the home. The providers and registered manager are experienced in social care and Mrs Anson is also a qualified nurse with an active pin number. The registered manager has also obtained the registered managers award.
Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 21 Mrs Anson also undertakes a monthly quality audits of the services and facilities provided and issues a report of her findings to the Commission and registered manager. The evidence indicates that residents’ financial interests are safeguarded and there are no apparent concerns about the financial viability of the home. A good standard of record keeping is evident and the providers have improved the records that did not meet the required standard at the last inspection. The records detail events, concerns or incidence and any action that is taken by the providers or staff. The records also provide staff with the appropriate information to provide the care and support required. Risks are positively managed about the environment and the equipment at the home. The arrangements to assess and manage risks that individual residents encounter continue to improve and staff have received additional training in this area Any assessments of risk are recorded and provide staff with guidance about the action required to promote the health, safety and well being of the residents. The assessments in respect of a resident’s mobility do not however always give staff clear guidance or direction and this is an area that would benefit from improvement. Resident commented they feel safe at the home and from the information provided by the registered manager action does take place to promote safe working practices that is not recorded. The providers have also established a range of policies and procedures that promote safe working practises. A recent inspection by the Fire Brigade highlighted certain improvements were required in regard to the fire risk assessment that had been completed by the providers. The other measures in place were found to be satisfactory and staff is regularly given training about Fire Precautions. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X 3 2 Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans must provide sufficient information, guidance and direction for staff to meet the assessed needs of service users in a safe manner. The environment and facilities provided must meet the required standard. Where a resident or staff member is potentially in a position of risk a suitable action pan must be established that guides and directs the action of the staff. A satisfactory fire risk assessment must be in place. Timescale for action 30/04/06 2. 3. OP19 OP38 23 13(a)(c) 30/12/06 28/02/06 4. OP38 23(4)(a) 28/02/06 Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 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. 2. Refer to Standard OP3 OP7 Good Practice Recommendations Where residents have complex needs or require the care provided in a specific manner the assessment records should be more detailed. Clear records should be made of each review and include the areas considered, any conclusions and any action required. Tremethick House DS0000009095.V263772.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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