Inspection on 26/03/09 for 120 High Street North

This inspection was carried out on 26th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

120 High Street North 23/03/07

120 High Street North 16/02/06

120 High Street North 14/03/05

120 High Street North 02/08/04

120 High Street North 18/11/03

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 120 High Street North 120 High Street North Dunstable Bedfordshire LU6 1LN The quality rating for this care home is: two star good service 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: Judith Roan Date: 2 6 0 3 2 0 0 9 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 Inspection report CSCI Page 2 of 32 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 120 High Street North 120 High Street North Dunstable Bedfordshire LU6 1LN 01582750940 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): caroline.jordan@mencap.org.uk Royal Mencap Society Name of registered manager (if applicable) Lisa Marie Carr Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: Date of last inspection 2 3 0 3 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home The home is a 6-bed service run by Mencap. The home is a semi-detached house to the north of Dunstable town centre. It has four floors. There is a spacious garden to the rear that can be accessed via the kitchen or utility room. The home is situated opposite a convenience store and is within walking distance of Dunstable town centre and public transport links. Care Homes for Adults (18-65 years) Page 5 of 32 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: two star good 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 Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home This was an unannounced inspection, which took place in the late afternoon and evening. We selected two people who use the service to case track which involved reviewing the care they receive through review of their records, meeting with them and observing practice. The inspection also took account of all information received since the date of the last visit and comment cards received. An annual service review was undertaken in March 2008 that did not change our view of the service provided. Care Homes for Adults (18-65 years) Page 7 of 32 Two safeguarding referrals have been made over the past year. These have been investigated and action has been taken to protect people using the service. Prospective users of the service are advised to contact the office to obtain up-to-date charges. Fees are according to level of support required. They include personal care, accommodation, meals, laundry and a seven day holiday. Additional charges include chiropody, toiletries, clothing and travel. People using the service said I had the opportunity to look around before I moved in and to spend time with people that lived at the home I am not really sure of how to make a complaint I can make decisions about what I do each day Care Homes for Adults (18-65 years) Page 8 of 32 Staff said The induction training was good Training is available to meet my needs High Street has a homely atmosphere Support is person centred What the care home does well 120 High Street is a warm and friendly home. You will be made welcome during your visit. Bedrooms viewed were clean and pleasant and contained personal items. Support plans are developed with people who use the service. People who use the service are involved with decisions made about the home and in developing their support plans. Care Homes for Adults (18-65 years) Page 9 of 32 People using the service are supported to be as independent as possible. The acting manager and support workers demonstrated that they provide a good standard of care and support to people who use the service. Creating opportunities to develop independence with everyday living skills is promoted. The home is clean and comfortably furnished. The home provides a choice of communal areas where individuals can spend time alone if they wish. Care Homes for Adults (18-65 years) Page 10 of 32 Support workers are trained with specific skills to meet the needs of people who use the service. What the care home could do better The provider must review medication storage facilities at the home to ensure that controlled drugs can be safely stored and meet the new regulations that came into force in 2007. People using the service need to have the opportunity to discuss how they can make comments and express concerns on a regular basis. Care Homes for Adults (18-65 years) Page 11 of 32 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 Judith Roan Cambridge Office Capitol Park Fulbourn Cambridge CB21 5XE Tel 01223 771300 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 12 of 32 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 Care Homes for Adults (18-65 years) Page 13 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The admission process ensures that needs are assessed and that potential users of the service are fully involved within the process. Evidence: All of the people living at 120 High St have lived at the home for several years. It is evident that continuous assessment is carried out to take account of individuals changing needs. For new admissions a process would entail the manager and members of the support worker group spending time with the person considering the service, their family, gathering detailed information from any previous placements and the funding authority. The information is updated with ongoing work especially in relation to health care needs. The statement of purpose and service users guide has been updated and contains the required information set out by the Care Homes Regulations 2000. The homes statement of purpose sets out the aims and objectives and details the facilities and services provided. One person completing the survey confirmed that this information was available to help them make a decision about the suitability of the home. The service users guide also provides confirmation of what can be expected for people already using the service. The manager states that all information about the Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: service is being reviewed and transferred to different formats Mencap have an assessment tool and a clear admission procedure that includes obtaining copies of all relevant assessments. The registered manager has worked to update files with this information. Review of individuals files identified that there was a copy of a licence agreement signed by people using the service. This agreement details the charge, and cost each person would need to pay to the housing association and Mencap. The agreement states what is included within the charge i.e.; accommodation, food, heat, light and other services including a contribution towards support or care. Funding authorities supporting each person also top up fees. Care Homes for Adults (18-65 years) Page 15 of 32 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 . The care files of two people using the service were reviewed and reflected current needs. Support plans have been updated and are reviewed as required. The outcomes for people who use the service are positive. In discussion with people who use the service they confirmed that their needs are met and that support staff always involve in every aspect of their care. The support available for individuals enables them to develop their skills and participate in everyday activities that they may not previously been able to achieve. Personal learning is achieved by the consistent approaches used by support workers and opportunities for individuals to and observing a broad spectrum of daily living activities. Risks within activities are considered on an individual basis and plans made to minimise these for each person. Everyone is encouraged to be as independent as possible with appropriate support. In this way people using the service are included within activities and not excluded because of any behaviour that may arise. Support plans are in place and are continually updated to meet peoples changing needs. Support workers confirmed that each person is involved in the development of their Care Homes for Adults (18-65 years) Page 16 of 32 Judgement: plans within their ability. They also demonstrated during the inspection the importance of the person using the service and their family/advocate being involved. In discussion with the manager and a statement made within the AQAA support plans and meeting individual needs has been a high priority since they took on the role as manager. They also acknowledged that more work is still required and that support plans and records need to demonstrate how people using the service achieve their agreed goals. The AQAA states that Care plans need to be more accessible to the individuals. Service users need to be more aware about the use of the information that is kept about them. Evidence: People using the service can expect practices within the home to promote their involvement and independence. Care Homes for Adults (18-65 years) Page 17 of 32 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 using the service benefit from having a healthy diet and good opportunities to develop their skills and maintain contact with family and friends. Evidence: Individuals have a weekly activities programme that is updated to take into account of various events and personal choices. New activities are tried out to extend the choices and experiences for each person. Careful planning is undertaken for all activities to ensure that people who use the service and support workers are protected and enjoy the experience. Experiences are good and varied. It was noted that several people attend day services and that social histories are now held on files. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: People using the service are fully involved with day-to-day living tasks within the home. In observation support workers enable people to carry out tasks and help only when necessary to demonstrate and develop a skill. It was clear that individuals were positive about their achievements. Throughout the inspection the inspector observed positive work with individuals using strategies noted within the support plans in supporting people with their identified needs. The meals are freshly cooked and healthy. Individuals are supported to make healthy choices and have a balanced diet, with opportunities to have the occasional not so healthy treat. Support workers have a good understanding of the needs for people who use the service and use the meal times to develop communication skills with each other. Meals were seen to be a very social event at the home. There is much negotiation between individuals so that meal times can be arranged around social activities. A food diary is kept to ensure that a balanced diet is provided. Individuals are supported to maintain good communication with families with one person being supported to visit an elderly parent and another to continue the contact with their previous home area. Records supported these activities. People spoken to during the inspection said that we can do what they liked and enjoyed living at the home There was evidence of leisure activities going to colleges, discos, local pubs etc. Case records show details about activities undertaken and holidays taken. Residents Meeting notes showed that they have been consulted and trips are planned in the future. Support workers said that the service offers a good choice of social activities and that the home has an informal relaxed atmosphere. The homes location means there is good access to local shops and community facilities. Visitors are welcome at the home and there are no restrictions on visiting times. Although we received no surveys from relatives or advocates of people using the service said that we are supported to see our families. Families are encouraged by Mencap to complete regular questionnaires about their views on the service. Care Homes for Adults (18-65 years) Page 19 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using the service receive good personal support with their physical and emotional health needs being well met. Evidence: There is a very comprehensive information kept which details all medical appointments and check ups on an individual basis - from nurses, GPs, dentist, etc. Care Plans indicate all aspects of service users health care needs are covered e.g. management of personal care, monitoring weight, communication, social skills, work and play etc. Accident and Incident Records were checked and it was found that staff had reacted appropriately to all situations presented. The AQAA states that The pharmacist and Mencap had trained all staff administering medication. A distance learning pack is available for staff, which they were expected to complete. Support worker training records supported this. The home has a policy and procedure for the safe administration of medications. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Medication records were checked and found to be up to date. Medication is kept securely locked away. The provider needs to seek appropriate advice on the storage of controlled drugs since the change in the regulations last year that requires all care homes to have facilities in place. Care Homes for Adults (18-65 years) Page 21 of 32 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 . Robust procedures and active listening to their views protect the welfare of people using the service. Evidence: People using the service said that if they were worried about anything they would speak to staff or the Manager and they thought it would be followed up. Most surveys also confirmed that people know how to complain and raise a concern. One person however did not know how to complain and it is recommended that the manager has regular discussions at meetings to remind people of what to do. The last AQAA received confirms that The complaints procedure is easily accessible in written format and all service users are aware that they should speak to a member of staff if there is something they are unhappy about. There is a copy of Mencaps complaints procedure in the communal area and Mencap has also produced an accessible version. The Commission for Social Care Inspection has received one complaint regarding the service since the last inspection about the lack of support for one person using the service. Appropriate action has been taken to redress the actions of support staff on shift at the time. The Complaints Procedure seen by the inspector reflects the National Minimum Standard in that it has set stages linked to timescales. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: People using the service have regular meetings where they are invited to share their views about the home. A record of these meetings is available for people living at the home and staff to refer to. The staff surveys confirmed that they had a good understanding of whistle blowing procedures and how to raise concerns about abuse. The home has policies and procedures, including the No Secrets and Protection of Vulnerable Adults documents. Training is provided on adult protection. There have been two safeguarding investigations at the home that have led to action being taken to protect people that use the service. New risk assessment have been undertaken for one person using the service to ensure that they are supported appropriately with activities outside of the home. Staff recruitment checks include a Protection of Vulnerable Adults (POVA) first check and a Criminal records Bureau disclosure (CRB) for everyone that works at the home. Two references are also completed. Staff all have POVA training as part of the induction process and this is regularly updated. Care Homes for Adults (18-65 years) Page 23 of 32 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 . The home provides a warm family setting with individual space that is well maintained clean and hygienic. Evidence: The home on four levels is decorated to a good standard. There are adequate rooms to enable everyone to have their own personal space. Several communal areas are used for joint activities and each bedroom has sufficient room for personal hobbies. Communal areas are comfortable and provide areas where people can relax. Individual bedrooms are personalised, comfortable and well maintained. People using the service are supported in maintaining their rooms to a high standard of cleanliness and safety. The housing association is contracted to decorate the internal walls every 5 years to ensure the home is kept in good repair. A wheelchair ramp and walk in shower have been installed to enable one person with mobility needs to have access to facilities. There is regular maintenance that ensures the safety of the home. Records confirm that Health and Safety checks are completed on a regular basis and meet national standards. People spoken with during the inspection said that We like our own rooms and have chosen how it has been decorated. Bedrooms seen showed individuality and contained Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: items to suit their lifestyles. Standards of cleanliness and odour control in all areas of the home were good. Care Homes for Adults (18-65 years) Page 25 of 32 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 . Staff skills and recruitment practices ensure that the needs of people who use the service are supported and that they are protected. Evidence: In reviewing files it is clear that Mencap has a thorough recruitment procedure and files seen contained the required employment checks - application form, two references, criminal records bureau disclosures(CRB) and interviews that involve people who use the service had been undertaken. The AQAA confirms the above process and states The recruitment process includes written and group work assessments as well as a one to one interview to gain a more rounded view of potential staff. Staff also undergo all the necessary CRB, Protection of Vulnerable Adults and Two reference checks. These can all be found in staff information files. The surveys indicate that support worker team have a sound knowledge base about the needs of people that use the service. Support workers are offered a range of opportunities to train. Of the staff team of four two people have National Vocational Qualification (NVQ) at level two or above. This meets the national minimum standards. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: Support workers have access to a wide range of topics - the Person Centred Planning system which identifies service users individual needs, Lifestyle Planning, Epilepsy, Communication, Health Action Planning, Risk Assessment, Report Writing, Fire, Food Hygiene, etc; Training records are kept within individual staff files. New support workers have to go through a detailed induction programme, based on the Skills for Care professional model. One support worker confirmed that the induction process was very thorough in the staff survey. Support workers have regular supervision, which are recorded. One member of the staff team did however say that the receiving of these records are at times delayed. Care Homes for Adults (18-65 years) Page 27 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service is person centred and effectively managed in the best interest of people who use it. Evidence: The acting manager effectively manages the home in the best interests of people who use the service and the support workers. There was good feedback from people who use the service and most support staff about the role of the manager. There are several internal meetings within the service that focus on person centred care and enable people to voice their views and choices. All meeting have clear and comprehensive records. The acting manager reviews the service through the continuous improvement plan with their manager on a monthly basis. In addition monitoring forms are completed to ensure that the service develops and maintains a quality assurance system. All meetings at the home are recorded and demonstrate how the views of people using are fed into the ongoing review. The last AQAA was received in August 2007 and this Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: was reflective about the future development needs of the service and shows that the management team are proactive. Due to the change in manager CSCI have not received this document for this inspection year and have requested that this is sent as soon as possible. The provider has undertaken all health and safety checks required. Clear records of all checks are well maintained. The AQAA also confirms the checks undertaken. Mencap has robust financial checks of personal monies that require records of receipts, running balances and two signatures. Monies are checked daily to ensure they are correct. Health and Safety Policies and Procedures are in place. The detailed induction training ensures staffs knowledge and understanding of these. Care Homes for Adults (18-65 years) Page 29 of 32 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 Care Homes for Adults (18-65 years) Page 30 of 32 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 1 20 13 31/08/2009 The provider must review storage facilities at the home to ensure that controlled drugs can be safely stored. If controlled drugs were to be prescribed the provider must ensure that they meet the regulations that came into force in 2007. 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 1 22 That people using the service have the opportunity to discuss how they can make comments and express concerns on a regular basis. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.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. Copyright © (2009) 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. 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