Care Home: Lemsford Road

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lemsford Road 66 & 66a Lemsford Road St. Albans Hertfordshire AL1 3PT three star excellent service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jeffrey Orange Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Lemsford Road 66 & 66a Lemsford Road St. Albans Hertfordshire AL1 3PT 01727850436 01727810723 Lemsford.Road@unitedresponse.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): United Response Name of registered manager (if applicable) Mrs Terri Jenner Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 11 11 0 0 care home 11 learning disability physical disability Additional conditions: Date of last inspection 2 8 1 2 2 0 0 6 A bit about the care home Lemsford Road is a large house divided into three separate living areas on three floors. There is another house in the large garden and also a large outbuilding called The Hut that is used for activities and staff training. About your room Each person has their own room. Each living area has its own lounge, kitchen diner, laundry and bathrooms. There is a large garden to the side and rear of the house. Where your home is Lemsford Road is a busy road about one mile from central St. Albans. It is easy to reach the shops and leisure activities in the city. It has good access to major roads (M1 and M25) and there are good bus and train services available. The home, which is owned by Aldwyck Housing Association, is staffed and run by United Response. It offers care services for 11 adults with learning and physical disabilities. The current fees for care and accommodation are one thousand three hundred and fifty five pounds a week. Lemsford Road pays for one holiday a year for each resident and some outings and activities throughout the year. Copies of the latest report from the Commission for Social Care Inspection (CSCI) are available in the home. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We started our inspection early in the morning and stayed in the home until lunchtime. This meant that we could meet the people who live in the home as they were getting ready to go out for the day to different places. Before they went out we spoke to two of the people who live in Lemsford Road and saw other people as well. People have sent us surveys telling us what they think about living in Lemsford Road, we have also received surveys completed by people who work in Lemsford Road and from relatives of people who live in Lemsford Road. These have been very helpful and have given us a lot of important information. The manager sent us a long document called an AQAA. This is a self-assessment document that says how well people living in Lemsford Road are being looked after and how things might be able to be made better. It also has some interesting facts and figures for us to look at. While we were in the home we talked to people who work there and to the manager. We walked around the home and grounds and looked at how well they are looked after. We were able to look at some important paper records about the way the home is run and organised. This included details about how people who live in Lemsford Road are helped with any medicines they need to help keep them healthy and to the care plans that they have helped to put together. What the care home does well One person told us that I like it here and everyone that sent us surveys told us that they thought Lemsford Road provided good care for the people that live there. When we were in the home it was calm, pleasant and relaxed and everyone seemed to be getting on with each other very well. We found that people who work in the home had done the paperwork they have to do very well to make sure that the records were correct and up to date. When we talked to people who work in Lemsford Road they said We work together as a team which is good. The manager does a good job looking after people who live in Lemsford Road and in helping and supporting people who work there. What has got better from the last inspection There have been improvements to houses, including a newly fitted kitchen and some decoration and this makes it nicer for people who live or work in Lemsford Road The manager has made sure that all the things we asked her to do after our last visit have been done. People who work in Lemsford Road have done a lot more training to help them to help people who live in Lemsford Road even better. What the care home could do better Some parts of the houses still need painting and looking after better. It would be good if people outside of Lemsford Road could help the manager to find even more things for people who live in the home to do during the daytime. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jeffrey Orange Cambridge LO Capital Business Park Fulbourn Cambridge CB21 5XE If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who are considering Lemsford Road as a home for themselves or someone they are responsible for can be confident that before admission there will be a thorough assessment of their individual needs and an individually tailored process of introduction to the home that should ensure that only those people whose needs can be met fully are admitted. Evidence: When we looked at the information that the home provide to people considering moving into Lemsford Road, we found that it is comprehensive and very specific to their individual needs, for example being provided in a format that they can readily understand. The information provided includes details of terms and conditions, any licence agreements and contracts for the accommodation and care and also copies of recent reports on the home by the CSCI. This means that everyone concerned can have a very clear idea about how well the home achieves good outcomes for people living there and what charges apply for both care and accommodation. When we discussed the assessment and admission process with the manager and looked at supporting evidence, we found that it is exhaustive and thorough. We were told that it can take up to four months, including visits and overnight stays where that is appropriate. The process involves all relevant parties, is centred on the individual concerned and has helped achieve the current settled service user group that provides valuable consistency and continuity for the people who live in Lemsford Road. Evidence: In order to take account of the feelings of people who are already living in Lemsford Road the process can involve initial meetings outside of the home for example at day care so that they can develop a relationship with the person being assessed in a familiar and neutral setting. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in Lemsford Road can be assured that they will be encouraged and supported to control their own lives to the greatest possible extent. This will be done within an individual framework of risk assessment that ensures that they can do so safely, whilst also recognising the need for them to be able to take reasonable risks. Evidence: When we looked at care plans we found that they included evidence that they are regularly reviewed and that any changes in need are identified, with appropriate action taken to ensure that those needs are met. When we talked to the manager, she explained how, in the past, someone living at that time in Lemsford Road had been helped to find an alternative place to live, where their increased nursing needs could be more effectively met. This indicates not only that the needs of people who live in the home are kept under review, but also that the home will take appropriate action when it assesses that it can no longer meet those changed needs satisfactorily. Care plans are very comprehensive and include a wealth of individual, person centred information including My Health documentation produced in conjunction with the local adult social care and NHS Trust bodies covering Lemsford Road. We were informed that one person has a sound based care plan and that United Response are introducing care plans in a touch screen computer based format, this indicates that the home are active in seeking the most appropriate and effective format for each person living in Lemsford Road. As well as individual personal care guidelines, we saw that there were a series of risk Evidence: assessments covering environmental risks, risk from others and risks to others. These risk assessments had been regularly reviewed to ensure that they still addressed current risks effectively. It was clear when we were able to talk to one person living in the home about some of the places they had been and the activities they had taken part in within the community that they have been able to access the community alone under guidance within a risk assessment framework. The system of risk assessment in the home is focused on expanding and finding opportunities to build confidence and independence rather than taking an over cautious and protective view of risks that could prevent people living in Lemsford Road achieving the greatest degree of independence that can be done safely. When we observed people who live in the home getting ready for the days activities outside of the home, we were able to see how staff were able and willing to respond to non-verbal communication in a way that enabled people living in the home who had no or only limited verbal communication to make choices and express preferences. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in Lemsford Road can be confident that they will be supported to access community activities and facilities and will be encouraged and enabled to maintain contact with their friends and family if that is what they want. Evidence: When we talked to people in the home about the leisure activities they told us about trips they have enjoyed both in the UK and abroad. When we looked at care plans we found that they were broken down into areas such as education, family and leisure etc. and gave details of how these needs or wishes were addressed and wherever possible fulfilled. When we talked to the manager about comments made in the homes AQAA about the availability of community facilities and support, we recognised that the restrictions placed on day care provision and college placements for example, which were entirely outside the control of the home, had been a concern for them because of the affect they have on people living in Lemsford Road. The home have been proactive and resourceful in finding alternatives to ensure that they offer people living in the home as good a range of activities and social outlets as possible. They told us of some success they had in obtaining alternative day care for one person, with one other person currently on awaiting list. They are also looking at how the staff rota can be adjusted to provide more one to one time with people living Evidence: in the home. Shortly after we arrived, people started to leave the home for a variety of day time activities and we were told that something had been planned for each person to do. There were details of holidays that already taken place and others that were being planned as well as a range of social activities for example visiting pubs, cinemas and trips at special times of the year such as Christmas. We were shown The Hut which is a building in the grounds of the home that has been provided with an interactive touch screen multi media centre by one of the residents parents for the use of all people who live in the home and which also has a sound and sensory experience area that we were told is very popular with people living at Lemsford Road. We saw evidence of menus in place and saw that these reflect the likes and dislikes of people living in the home as well as their nutritional and dietary needs. There was evidence in care plans of the active involvement of families and friends with people who live in the home in line with their wishes. All of the interactions we saw during this inspection visit between care staff and people living in the home were appropriate and demonstrated a proper degree of mutual respect. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in Lemsford Road can be confident that they will be supported to access the health care services they require to maintain their health and well-being. Evidence: When we looked at the person centred plans of people living in Lemsford Road we found that they contained precise details as to how, when and where a persons personal care was to be given. The homes AQAA told us that all personal support is provided in private with the same sex carers where that is possible. Care plans seen include assessments for specialist equipment, although the current level of need in the home in this respect is low. These assessments are kept under review to make sure that any changes are identified and acted upon and this demonstrates that people living in Lemsford Road who require specialist equipment or services will have them provided, subject to assessment. When we discussed with the manager what would happen in the event that a persons health needs can no longer be adequately or appropriately met, we were informed of an instance where this had been the case, which resulted in a process of consultation with all individuals and health and social care agencies involved and led to the move of the person concerned to a nursing home where their health needs could be satisfactorily met. The degree and detail of health related information in respect of each person living in the home is exceptional and should ensure that any health care needs are recognised and met. Evidence: Whilst we were visiting the home, we met on person living in the home who was about to go to the GPs in order to review their medication and care plans and daily notes contained very detailed information about routine interventions and appointments with health care services either in the community or the home. This shows that people living in Lemsford Road have ready access to the health care services that they require. When we looked at the way that the home records and administers medication for those people living in the home who require assistance we found that it was essentially sound and all of the records checked were found to be in order, which suggests that people living in the home are adequately protected by the medication practises of the home. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Whilst the potential for abuse can never in practise be entirely removed, people living in Lemsford Road can be assured that they are well protected by staff training and by the way policies and procedures intended to protect them are reinforced and put into action, which provides confidence that any instances of abuse that may be seen or suspected would be identified promptly and dealt with appropriately. Evidence: Those people contacted during this inspection process have all indicated that either they, or those that they are responsible for feel safe and well protected in the home and that they are aware of how to raise any concerns they might have. When we looked at the complaints policy we found it was easy to understand, was readily accessible and available in appropriate formats, including pictorial, which should ensure that everyone can make sense of it and know what to do if they need to complain. The complaints policy and whistle blowing procedure are included in the handover files that are given to staff at each change of shift and we were told in the AQAA that staff are encouraged to report any concerns that they have even if it is just a feeling. When we spoke to care workers they each had a good understanding of what abuse is, what whistle blowing is and what to do if they saw or suspected abuse was taking place. When we looked at recruitment files for care staff we found that they contained evidence of rigorous checks that had been made to make sure that unsuitable people were not employed to care for people living in the home. Each person living in the home has a risk assessment in place to detail any risks they may face from other people, including financial abuse. When we looked at financial records kept by the home in respect of money held on behalf of people living in the Evidence: home, we found that random totals checked agreed with the records and that there was an exceptionally robust system of routine checks and audits in place to ensure that records were maintained accurately. When we looked at staff training records, we found that they included evidence of further training in the safeguarding of vulnerable adults that is to take place in December this year and throughout next year. United Response have demonstrated an open and proactive policy of notification to the CSCI and other health and social care agencies in any instances of concern involving their care staff and have been robust and rigorous in the action taken to protect people living in this service. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Lemsford Road provides a safe, comfortable and homely environment for those people who live or work there. Evidence: When we walked around the home with the manager we were able to confirm that action had been taken to address the concerns raised in our last inspection, including the replacement of one kitchen and some general decoration. We were told that the ground floor bathroom is due to be refurbished completely in January 2009. When we saw the bedrooms of people who live in the home, we noted that they were decorated and furnished in an individual way, to reflect the persons taste and interests. The home was clean and tidy on the day we visited and the manager confirmed that emergency repairs are attended to by the Housing Society responsible without delay and that in general they were reasonably prompt to deal with non-urgent matters although there were times when some delay was experienced. It is important that the overall appearance of the home is maintained well, as this enhances the experience of those people for whom Lemsford Road is their home. In their AQAA, the home informed us of routine checks and environmental audits that are done monthly to ensure the safety and wellbeing of people who live in the home. We saw a report from a Local Authority Environmental Health inspection carried out in May 2008 covering health and safety and food hygiene, no major issues were raised and the home have written confirming that any action required has been taken. This indicates that the manager takes the health and safety of the people living in the home and the maintenance of high standards of hygiene appropriately seriously. Evidence: The garden has been recognised as an underused asset by the home and the AQAA indicates that subject to funding they hope to make better use of the outstanding space and potential the grounds of the home represent. The Hut is an important part of the homes facilities, which benefit those people living in the home who want, for example, to make use of the interactive and sensory equipment provided there. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in Lemsford Road can be confident that they will receive care from a well-trained and supported staff team with the skills and experience required to meet their needs. They can also be confident that they are protected by the way that staff are recruited to work in the home. Evidence: We are all encouraged to do training and We are always given the opportunity to do other training which we feel we might need are only two of the very positive comments about the availability of training for staff that care workers made to us. When we looked at training records for staff, we found that they were comprehensive and up to date and that in additional to basic training they included specific training appropriate to the people living in Lemsford Road such as autism, supporting people with complex needs and intensive interaction. The majority of staff have also undertaken at least level two in the appropriate national vocational qualification (NVQ) and several have more advanced NVQ. All of this shows that Lemsford Road gives a high priority to the training of staff and means that people living in the home benefit from receiving care from a skilled and well-trained team of care workers. When we received comments from people who live in the home in the form of pictorial surveys they all said that the staff treated them well and that care staff listen to and act on what they say. Relatives were also very positive about communication with the home and care staff and also paid tribute to the standard of care they observed I personally feel that the manager and staff go the extra mile so that the service users have as full a life as possible When we looked at how staff were recruited we found that all the checks required to Evidence: ensure that people living in the home are cared for by suitable people have been carried out thoroughly. On the day of the inspection there were an adequate number of staff on duty to meet the needs of the people living in the home and staffing levels were not raised as a particular concern by either staff or relatives, recognising that in both cases even more staff would always be welcomed. When we spoke to staff and the manager and looked at records of staff supervision we found out that this was structured and regular and ensures that care staff are supported to carry out the demanding work that they do, which in turn benefits the people for whom they provide care. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Lemsford Road is a very well managed home with the needs and welfare of people living there at the centre of management decisions made. Evidence: When we received the AQAA from the manager we found that it was exceptionally well completed, with clear evidence of an ongoing assessment and development plan for the service and a realistic appraisal of how well the service performs and how it can be improved. This, together with evidence seen of a corporate quality assurance process indicates that people living in Lemsford Road benefit from a service that is always challenging itself and seeking ways care outcomes for them can be improved. When we spoke to staff or received comments from them in surveys, they were all very positive about the support that they receive from the manager. Relatives of people living in the home were also very positive about the high quality of management they saw in the home. The standard of record keeping seen was high and offers protection to people living in the home in respect of health and safety, medication and risk assessments. When we checked the system of recording for financial transactions undertaken on behalf of people living in the home, we found that it was robust and thorough, amounts of money checked were accurate and the system is subject to an external audit process. This should give confidence to people living in the home that their financial interests are safeguarded. The manager has shown a willingness to take firm, appropriate action in the event that the policies and procedures of the home are not carried out fully and this, together with a thorough knowledge of the developing care needs of people living in the home and very clear and effective communication structures in place means that people who Evidence: live in Lemsford Road are kept at the very heart of all decisions made about the management and administration of the home and that their welfare and wellbeing is given the highest possible priority in the way the service is run. The manager is well-qualified, with a very good understanding of the care needs of people in the home and when we talked with her we found that she had a very good and clear understanding of current developments in care nationally and was committed to a process of continual development not only for her staff, but also for herself. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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