CARE HOMES FOR OLDER PEOPLE
Trengrouse House Trengrouse Way Helston Cornwall TR13 8BA Lead Inspector
Lynda Kirtland Unannounced Inspection 6th February 2006 11:00 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 Trengrouse House DS0000009139.V273120.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. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Trengrouse House Address Trengrouse Way Helston Cornwall TR13 8BA 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) 01326 573382 01326 563917 Cornwall Care Limited Mrs Maureen Williams Care Home 44 Category(ies) of Dementia - over 65 years of age (42), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (6) Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Service users to include up to 6 adults of old age (OP) Service users to include up to 42 adults aged over 65 with dementia (DE[E]) Service users to include up to 2 adults aged over 65 with a mental illness (MD[E]) Total number of service users not to exceed a maximum of 44 Date of last inspection 14th June 2005 Brief Description of the Service: Trengrouse House is one of eighteen homes owned by Cornwall Care Ltd. It is registered to accommodate forty-four older people in need of personal care, who may be suffering with a degree of dementia and are over retirement age. Admissions are on a planned bases and emergency admissions are avoided whenever possible. Trengrouse House provides one bed for respite care. Trengrouse House is a single storey dwelling. The shared bedrooms have been altered into service users bedrooms for single occupancy. Therefore there are forty-one bedrooms for service users, which are for single occupancy. Trengrouse House is fully accessible for service users who have mobility difficulties or use a wheelchair. There is a sensory secure garden area that all service users are able to access. Trengrouse House has close links with Age concern, and the local community. The home is located centrally to the town of Helston and offers a day care facility for up to seven local people. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Trengrouse Residential Home on the 6 February 2006 and spent over four and a half hours at the home. This was an unannounced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 14 June 2005. In addition the inspector focused on the following key areas of care: care planning, health care, leisure, complaints, staffing and some management areas. On the day of inspection 37 service users were resident in the home. The methods used to undertake the inspection are to meet with a number of residents, visitors, staff and the registered manager to gain their views on the services that Trengrouse House offers. Trengrouse House records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
Service users and their representatives stated that Trengrouse House provides good quality care and accommodation. Additional comments were made about staff such as; they are ‘kind’, ‘caring’ and ‘patient’. Residents commented that they felt that they were consulted about their care needs which staff ‘ met at all times’. Residents and staff commented that there are sufficient staffing levels on duty. Trengrouse House has a stable staff team that allows staff and residents to get to know each other well and provide consistent care to residents. Residents were complimentary about staff skill and attitude. Residents commented that the welcome to the home was a positive experience and ‘relieved anxiety’ about moving into a care home. Residents commented that they have access to health care and felt that all their health needs were met to a ‘good’ standard Residents confirmed that there was a varied and stimulating programme of activities that is provided by the home and local community. These were observed during the inspection. Residents felt their visitors were welcomed to the home. Residents, relatives and staff stated that if there were any issues they felt able to approach the registered manager directly and that their ideas would be listened to and where appropriate acted on. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 6 Cornwall Care prioritises staff training and is keen to continue to develop staff skills. Staff were complimentary about the training they receive and support form the management team. What has improved since the last inspection?
Since the last inspection the home has amending it’s registration certificate. The home has expanded its provision of providing care and accommodation to service users who may suffer with a degree of dementia. Therefore the home specialises further in this area of care. Staff have all attended training in the areas of older peoples and dementia care. With the change of registration needs are more complex. The levels to ensure that resident’s levels on duty. Therefore there shifts. categories, some of the residents dependency registered manager has recalculated staffing care is met at all times with sufficient staffing has been an increase in staffing levels on day Trengrouse House continually invest in the environmental aspects of the home, so that a redecoration and refurbishment of the home is ongoing. Some of the recent alterations have been to alter office space and now have the facility of a staff training room, new lobby area, seating in the lounge areas have been altered and now encourages more socialisation between residents, new TV, carpets, completion of the sensory garden and purchasing of kitchen equipment. Trengrouse House have implemented the ‘food project’. Feedback from residents was complimentary about the quality, quantity and presentation of food. Observation of lunch was seen to be unrushed social occasions with choices of main meal and deserts from the menu. Cornwall Care Ltd is continuously looking at how to develop the service they provide further. They have been changes to Cornwall Care ltd management team and the registered manager felt that this has influenced positive changes within the organisation. For example an up to date computer system has been installed in all Cornwall Care homes. What they could do better:
From this inspection three requirements and four recommendations have been identified. It is required that the registered manager must amend the homes statement of purpose to reflect the changes of registration categories. The other requirements and some recommendations are in respect of medication issues. At this inspection it was noted that medication records did not tally with the actual medication present in the home. Therefore
Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 7 requirements were identified for the registered manager to audit recording of medications to ensure that accurate records of the receiving, administration and disposal of medication are kept and correspond with the amounts of prescribed medication stored in the home. Service users medication sheets must accurately record what medication has been prescribed to them, and if refused medication this must be evidenced with appropriate records maintained. Recommendations were also made in respect of transcribing medications and to ensure that the medication fridge temperatures are monitored. Two other recommendations were identified as good practice. The registered manager should evidence that she has audited service users accounts. In addition Cornwall Care Ltd is in discussion with CSCI regarding the adult protection policy. Due to the delay in CSCI receiving this information a recommendation has been identified to this effect. This inspection highlighted that Trengrouse House provides a good standard of care to residents. Residents and staff could not think of any improvements that Trengrouse House could make. The inspector would like to thank the residents, staff and management team for their assistance during this inspection process. 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. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 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 Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: This section was not inspected as it was assessed at the previous inspection and met the guidelines of the national minimum standards. The registered manager acknowledged that the homes statement of purpose needs to be updated to reflect the recent change of registration status and will forward a copy of this to CSCI when completed. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 10 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): 8,9,10 Health care needs are met to a good standard. Medication is administered by trained staff and stored securely. Records to evidence satisfactory administration of medication must be more robust. The staff at the home builds positive relationships with residents that are based upon the residents dignity and privacy. EVIDENCE: In discussion with the registered manager and staff it was evident that the care planning system has not altered since the last inspection therefore this was not inspected. Residents commented that health needs are met by the staff at the home and by external professionals to a high standard. Detailed records of all health professional visits to individual residents further evidenced this i.e. CPN, speech and language therapist, chiropodist, dentist, optician and physiotherapist. Cornwall Care Ltd has produced a detailed corporate policy in the ordering, administration, storage and disposal of medication. Designated staff attends annual training in this area of care. In addition the home has a contract with
Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 11 the local pharmacist to ensure that medications are ordered, administered, stored, disposed of correctly, and will provide a audit of their practice. Medication sheets were inspected and in the main completed correctly in respect of recording when medication had been administered. The inspector noted that improvements in the recording of medication is needed in the following areas: if a resident refuses medication this must be recorded, as current practice is not to complete the MAR sheet: if the medication is altered this must be witnessed by two staff members (known as transcribing). The most concerning element was that as the home has a system of monitored dose system and loose tablets and as medication amounts had not been carried over on to the following MAR sheets that it was not possible to complete a auditing trail of medication. When the inspector attempted this with staff, tablet counts did not tally with what the sheets had recorded. In addition the MAR sheets had recorded that tablets had been dispensed, which staff stated the home had not received (as said they were no longer needed) and therefore there was a discrepancy in what medication is recorded to have been received into the home and what was actually present. This was also the case in the controlled drugs cupboard, although a note in the returns book showed that medication had at one point been returned but the new sheets still stated that a repeat prescription had been made. In some cases medication had been prescribed to a individual service user but this information was not transferred to the MAR sheets, therefore the administration of this medication could have been missed The inspector advised that the registered manager liaises with the dispensing pharmacist to ensure that MAR sheets are correct and that the amounts of medication that the home are prescribed to receive are evidenced accurately. The registered manager agreed to address theses matters immediately. The staff are aware of storage of creams at correct temperatures. However the inspector found 2 items of eye drops out of the fridge. Once opened they must be stored in the fridge: this was rectified immediately. The contents of the fridge were inspected and medication stored in this area was satisfactory. The inspector recommended that daily monitoring of the fridge temperature be undertaken. All residents spoken with stated that staffs display a high standard of respect in their daily interactions. Residents stated that staffs ensure that their privacy and dignity is maintained and could not see how this area of care could be improved. The inspector noted that the atmosphere of the home and residents appeared to be relaxed. Residents commented staff ’ were ‘kind’. Residents confirmed that they can have a choice in receiving care from either a male or female member of staff on duty, when to rise/ retire to bed, have access to a private phone and can receive visitors in private. In addition the inspector observed staff interacting with residents in a professional manner at all times, alongside a sense of humour when appropriate.
Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 12 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): 12,13,15 Trengrouse house provide a programme of activities to promote and encourage the pursuit of residents social, educational and leisure needs. Flexible visiting arrangements are in place and visitors are welcomed at the home. A varied and nutritious diet is provided to all residents in a relaxing atmosphere. EVIDENCE: From discussions with residents they commented that there is ‘enough to do’ during the day. The inspector noted on the day of inspection a variety of activities taking place; socialising in lounges, film, music, reading and receiving visitors. Activities are advertised around the home so that residents can choose whether to participate. Some residents commented that they prefer to spend time in their own company and this is respected. Residents were able to recall a list of activities that occur such as exercises, crafts, coffee morning, and are currently organising activities for Easter and the summer fete. There is a flexible visiting policy and residents determine where they meet with their guests. Residents and their visitors felt they were welcomed to the home positively and could not think of improvements in this area. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 13 Residents made positive comments to the inspector in the variety and quality of food provided. Some made comments such as ‘its excellent’, ‘there’s lots of it’ and commented on the amount of choice. Residents were aware of the choices of meals available. Residents can also choose where to have their meals, either in their room or in the dining areas. The dining areas were observed to be a relaxed and social occasion. Cornwall Care Ltd has implemented the ‘Appetite for Life project’, which ensures a varied and appealing diet is provided to residents in a relaxed atmosphere. From observations it was noted that residents choose their meals from a serving trolley and enjoyed them with their choice of liquid refreshments. There was variety of two main meals, plus salads, and a choice of four deserts, residents commented this was ‘usual’. In discussion with the catering staff they felt the food project had gone well. Due to the increase in food preparation this has lead to extra demands in the catering staff time. Staff were aware of individual dietary needs and relevant training to catering staff has been provided. A recent Environmental Health Inspection has occurred and assessed the kitchen area as being compliant with regulations, recording that ‘good practices are in place’. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Trengrouse House has an appropriate complaints and whistle blowing policy. Residents, their representatives and staff are confident to raise any concerns. The adult protection policy needs to be reviewed so that staff are aware of the process of instigating an adult protection referral to ensure safety of residents and staff. EVIDENCE: Cornwall Care Ltd has completed policies in respect of the complaints procedures. Trengrouse House and CSCI have not received any complaints about the home. From the inspectors discussions with residents and visitors all stated that they had no concerns about the care or facilities that were provided by the home. Staff likewise commented they had no current concerns. The majority felt able to approach the management team if they had any concerns. CSCI have met with Cornwall Care Ltd management team to discuss Cornwall Cares corporate adult protection policy. CSCI are waiting for a draft version to be forwarded to them for consideration. Therefore this was not inspected further. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected EVIDENCE: This standard was inspected in detail at the previous inspection and was viewed to offer a safe and comfortable home to all who live, visit or work at the home. From a tour on this occasion this was seen to continue and it was noted that a refurbishment and maintenance programme is ongoing. The home was clean throughout. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 16 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 Suitable trained and experienced staff are employed in sufficient numbers at all times to meet residents care needs. EVIDENCE: Residents and relatives all commented that they felt there were sufficient staffing levels on duty at all times. Some staff did not share this view. Due to the change in registration category for the home, the level of staffing has increased during the day so that the staffing ratio to residents is now 1:5 ½, which is reflective of the residents dependency needs. Current staffing is now at 7 carers in the morning plus an assistant manger, registered manager, 2 general assistants and a cook. In the afternoons up to 4 pm the amount of carers is reduce to 5 but then increased at 6pm to 6 carers. Rotas also evidenced this. Residents were satisfied with the level of staffing in the home and all were complimentary about the care and approach they receive from the staff team. The registered manager stated that if care needs become more complex then she would review staffing levels and increase where needed. The inspector observed staffs that were competent in their work. The registered manager stated that all staff employed at the home has relevant POVA/CRB clearance, although this was not inspected. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 17 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, 32,33,35,37,38 The registered manager is competent in her role to manage the home. The management approach creates an open, positive and inclusive atmosphere for residents and staff. Financial accounts for residents are maintained robustly. EVIDENCE: The registered manager, Mrs Williams, has worked at Trengrouse House for sixteen years. She has been the manager for Trengrouse House for the last 4 years. She has a vast experience in working with older people. Mrs Williams is keen to update her training and attends relevant training courses appropriate to her work. Mrs Williams has completed the Registered Managers Award level 4 in care. Residents, visitors and staff stated that Mrs Williams is an experienced and supportive manager and spoke positively about her skills. The staff team, service users and relatives perceive Mrs Williams to be a competent manager.
Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 18 From inspection of documentation it was evident that the staff meet with the management team approximately 2 monthly. Staff felt that these meetings were beneficial. Residents hold a ‘residents meeting’ approximately three monthly, as do the ‘friends of Trengrouse House’, minutes was inspected and demonstrated comprehensive discussions in gaining their views on future service provision. The registered manager completed a quality assurance survey with residents, and relatives, and stakeholders in June 2005. The results were 88 overall satisfaction with the care provided. Cornwall Care Ltd is currently reviewing their quality assurance systems, as they want to expand their current remit. Cornwall care Ltd have cooperate policies in the management of service users monies. Residents, or their representatives are encouraged to manage their own monies and hold their own accounts. However they can sign an agreement to request that Cornwall care assist them in the management of a small amount of their monies. From inspection of service users monies records were accurate and tallied. The inspector recommends that the registered manager records when she has audited these records, as currently this is not evident. Records held by the home are stored in a confidential manner and in the main are in line with the Data protection Act. Monthly reports by the group manager are undertaken and a copy forwarded to CSCI. Trengrouse House undertakes regular health and safety checks in the home i.e. fire drills, Legionella, emergency lighting, training of staff in the areas of COSHH, moving and handling and first aid. In addition inspections from other authorities occur and no issues have arisen from these inspections. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X 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 3 3 X 3 X 3 3 Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 20 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 OP1 Regulation 4 Timescale for action The statement of purpose must 30/03/06 be updated to reflect the categories of current registration in the home. The registered manager must 30/03/06 audit recording of medications to ensure that accurate records of the receiving, administration and disposal of medication are kept and correspond with the amounts of prescribed medication stored in the home. Service users medication sheets 30/03/06 must accurately record what medication has been prescribed to them, and if refused medication this must be evidenced with appropriate records maintained. Requirement 2. OP9 13,17 3 OP9 17 Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 21 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 4 Refer to Standard OP9 OP9 OP18 OP35 Good Practice Recommendations Daily fridge temperatures should be monitored and recorded. Transcribing of medicines on MAR sheets should be witnessed by two staff members A flow chart to inform staff of the process to be used in respect of adult protection procedures should be attached to the homes policy. The registered manager should evidence that she has audited service users accounts. Trengrouse House DS0000009139.V273120.R01.S.doc Version 5.0 Page 22 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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