Inspection on 25/04/07 for 72a Broad Street House 1

This inspection was carried out on 25th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

72a Broad Street House 1 27/04/09

72a Broad Street House 1 16/08/06

72a Broad Street House 1 19/01/06

72a Broad Street House 1 06/06/05

72a Broad Street House 1 20/12/04

72a Broad Street House 1 08/07/04

72a Broad Street House 1 13/01/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 72a Broad Street House 1 Ash And Birch Units Clifton Shefford Bedfordshire SG17 5RP Lead Inspector Mr Pursotamraj Hirekar Unannounced Inspection 25th April 2007 02:35 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 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 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 72a Broad Street House 1 Address Ash And Birch Units Clifton Shefford Bedfordshire SG17 5RP 01462 814196 01462 850689 Kathryn.chainey@hft.org.uk www.hft.org.uk Home Farm Trust 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) Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2006 Brief Description of the Service: 72A Broad Street (Ash and Birch) was a purpose built house owned by Home Farm Trust situated in a site recessed from the main street in the village of Clifton. On the same site was a second house provided by HFT for eight people with learning disabilities and the two houses shared a common paddock in addition to their individual gardens. The house was divided into two units namely Ash and Birch, each with a lounge, dining room and kitchen. One unit catered for people with Prader-Willie syndrome and the other for people with complex communication needs. Each service user had a single bedroom. In each unit were two bathrooms and a shower room with a total of seven toilets between the two units. Staffs were provided with a room with en-suite facilities, which were also used as the main office. This room was situated between the two units and formed the link on the first floor between both units. The ground floor link was the communal laundry. The homes current scale of charges was not provided. However the fees payable did not include newspapers, hairdressers, personal telephone, toiletries, or private chiropodist; these services would incur an additional charge. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection carried out on 25/04/07 over 3 ½ hours by Pursotamraj Hirekar. The new manager coordinated the inspection. The method of inspection included study of care plans, risk assessments, personnel records, staff deployment duty rota, relevant care delivery documents, discussions with manager and staff, conversation with service users’ and partial tour of the building. What the service does well: What has improved since the last inspection? What they could do better: The home must complete six monthly care plans reviews and update care plans of all the service users’. Each service user must be provided with an individual written contract or statement of terms & conditions, which must be signed by the management and the service user or their representative. Risk assessments must be reviewed by the home at appropriate and agreed intervals. The home must ensure that all the staffs’ records are at all times available for inspection. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Quality in this outcome area was good. This judgement was made using available evidence including a visit to this service. Information about the home was always readily accessible and there was enough information telling prospective service users how to access it, which enabled them from making a fully informed choice about the home and living there. Contractual agreements were revised for service users in a suitable format; however they needed to be signed by the management and the service users. EVIDENCE: The homes service user guide was available in a suitable format for the service users intended and provided information to enable prospective service users to make an informed choice about where to live. In response to the relatives & visitors comment cards reflected that some did not know how to access the last inspection report for the home. The home had now displayed the copy of the previous inspection report in the hallway. No new service users had been admitted since the last inspection. Therefore this standard could not be fully assessed. However there was evidence included within the records of the service users whose lives were tracked, which supported that the home had undertaken a full assessment of needs for each of them. The needs assessment was also supported by a health and social services assessment. The home had developed a service user plan from the assessment of needs. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 9 There was evidence that the home had begun to introduce contracts in a format appropriate to the needs of the service users. Each service user was provided with an individual written contract or statement of terms & conditions, which included the amount and method of payment of fees. However, the contracts need to be signed off by the manager and the service user. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area was adequate. This judgement was made using available evidence including a visit to this service. Service user plans contained satisfactory information, however further development was needed to ensure both the plans, and risk assessments were reviewed and updated at regular intervals. To ensure they accurately reflected service users changing needs and associated risks to enable the home to meet those needs and minimise risk to service users. EVIDENCE: The management had developed new tools for assessments and support plan which were in the process of computerisation and likely to be completed before July 2008, the manager informed the inspector. On this inspection, 3 service users’ care plan annual review records were seen. Service user – 1 annual care plan review was carried out on the 30/01/2007. Service user, reviewing officer Buckinghamshire, 2 support workers, team manager, and service manager participated. However, parents of service users’ apologised. The care plan review covered actions from the previous meetings, accommodation and internet facilities, daily activities and leisure, friends and 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 11 families, health - diet, dentist, optician, chiropodist, finance, risk assessments, agreed actions, and goals. The health action plan which included medication, health checks, oral and dental, eyesight, hearing, continence, healthy eating, fitness and mobility support required to be happy and emotionally well and relationship and sexuality review was outstanding. The manager informed the inspector on this inspection that the care plan would be updated followed by an internal half yearly review of the care plan that was scheduled to take place end April 2007. Service user – 2 annual care plan review was carried out on 26/02/2007. Service user, family members, support worker, social worker, and manager have participated. The care plan review covered areas such as accommodation, support needed, daily activities, hobbies and interest, friends and family, cultural and faith needs, money management, risk assessments, health, communication and goals. The manager informed the inspector on this inspection that the care plan would be updated followed by an internal half yearly review of the care plan that was scheduled to take place in middle of May 2007. Service user – 3 annual care plan review was carried out on the 05/01/2007. Service user’s father, key worker, team manager, reviewing officer, and service manager participated. The service user chooses to go on the computers rather than participating in the review. The review covered areas such as actions from last meeting, daily activities, friends and family, cultural and faith needs, finance, health, dentist, optician, epilepsy, support with continence, mobility, weight, communication, goals and agreed actions. Currently, the service user was in hospital and is likely to return home in July 2007 the inspector was informed by the manager. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area was good. This judgement was made using available evidence including a visit to this service. Service users were offered a healthy diet and were supported to access various activities and day care opportunities that enabled them to achieve quality of life goals. EVIDENCE: The home supported several service users to attend a local college twice weekly and many were also supported by the home to regularly visit a local resource centre, which provided planned educational and training activities. Service users spoken to say they were supported by the home to attend church when they wished to at times they wished to. Staffs were observed supporting those service users who wished to, to go shopping during the evening in the local community, which demonstrated a flexible approach to their support. There was evidence that the home supported service users to maintain family links and friendships inside and outside the home, in accordance with their wishes. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 13 The menu’s choices were in a suitable format for service users to make an informed choice and decide what they would like to eat. Some service users nutritional needs were closely monitored and assessed, including associated risk factors. There was evidence that the home managed service users nutritional and associated behavioural needs well. Service user – 1 day care and leisure activities are in tune with the assessed needs o f the service user, the activities included work at age concern 2 mornings a week, walking, swimming and visits to theme parks. The service user was happy with the routine of activities and enjoyed the same. Service user –2 daily activities personal care, shopping, walking, cinema, bowling, banking, swimming, Indian head massage once a month, 2 days a week at the college including once a week yoga classes. Have regular contact with family and go home frequently and attend church every Sunday. Service user – 3 the service user enjoyed jigsaws, puzzles and stickers. Liked working on the computer. The staff seems supporting her to plan for this September for a holiday at the lion king at Euro Disney as she had shown interest. The service user has an interest in animals and the home was exploring possibilities for taking her on regular visits to places with animals. The home had supported good family relations with the service user. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area was good. This judgement was made using available evidence including a visit to this service. The systems for the administration of medication were satisfactory. The service users’ receive support to meet their assessed individual physical and emotional needs. EVIDENCE: There was evidence that the home accessed outside healthcare professionals and services as required; in order to meet the healthcare needs of the service users. In addition the home was supported by a variety of healthcare services, accessible through a local resource centre. Medical visits were being recorded separately to daily notes and a variety of healthcare monitoring charts were in use. For example: Service user – 1 support to follow health diet, weight record and exercise was monitored, dentist, chiropodist and optician appointments were supported. Service user – 2 was supported by staff to do 3 diabetics read a day, all health appointments are up to date including dental, chiropodist, doctor, eyesight, diabetes including regular monitoring of weight. Service user – 3 was supported by the staff to have regular appointments with the dentist, optician, epilepsy monitoring referrals to doctor and hospitals, support with continence, mobility referrals to the physiotherapist, monitoring weight and communication which appears to have improved. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 15 The home had ensured all care staffs were trained in medication and the procedures implemented suggested that service users safety was being maintained. Insulin of a service user was being drawn up in advance, that had previously highlighted some concerns now demonstrated some safer practices. The inspector was informed by the manager that the nurses give insulin to service users’. The medication administration records (mar) were fully completed and no gaps were found when entries should be made, indicating that all medication had been administered in accordance with the stated instructions. The home had introduced new formats that help record information of staff trained to administer medication that was made available with staff’s initials. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area was good. This judgement was made using available evidence including a visit to this service. The arrangements for protecting service users were satisfactory. EVIDENCE: The home had a satisfactory complaints procedure that ensured service users felt their views were listened to and acted upon. The complaints procedure was produced in a format appropriate for service users to understand and access. The home had a Protection of Vulnerable Adults (POVA) policy in place. Most staff had also attended abuse awareness training, which included POVA. The homes policies and practices regarding service users money and financial affairs were satisfactory and protected service users from abuse. And a method or facility of safe storage for service users money & valuables has been now arranged in the office room. In response to the incident reported via Reg 37 on 23/02/07 of a su’s clock radio, the home had increased vigilance and the staff make sure that the service users’ lock their rooms when they go out. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area was good. This judgement was made using available evidence including a visit to this service. The standard of the environment within this home was good, providing service users with an attractive and homely place to live in which suited their needs. EVIDENCE: The home provided a purpose built, comfortable environment for service users, which was free from offensive odours with cheerful and well-maintained decoration and furnishings. The home was close to local amenities and transport if required. All rooms were single occupancy with en suite provision. Service users spoken to were clearly happy with their individual bedrooms and they had free access to them and were encouraged to take responsibility to maintain their cleanliness. Toilets and bathrooms were safe and suitable for their intended purpose and were in appropriate locations. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area was adequate. This judgement was made using available evidence including a visit to this service. The staffs and the service users had enjoyed good working relationship and benefited from wellsupported and supervised staff. However, the home need provide all the relevant documents on inspection with regard to staffs statutory checks. EVIDENCE: Staff training needs assessment was carried out and a month wise training plan for the staff was presented; the areas of training covered food hygiene, first aid, health and safety, moving & handling, induction, POVA, PCP, positive intervention and spars assessment. Staffs’ supervision was carried out every 6 weeks, on this inspection 2 staffs supervision record was seen and found staffs supervision was carried out as scheduled which benefited service users’ from well-supported and supervised staff. It was observed on this inspection that the staffs and the service users’ had good working relationship. Staffing level numbers within the home were maintained to meet the appropriate ratio based upon the needs of the service user, by regular use of agency staff, at least one on each shift. Staff files that were examined, the manager informed the inspector that the home had obtained satisfactory 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 19 checks and clearances on staff before their commencement and some staff records employed some time ago were held centrally and not in the home. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area was good. This judgement was made using available evidence including a visit to this service. The manager with the help of the staffs made adequate progress in compliance of requirements from the previous inspection and established good working relationships with the staffs, service users’, and relevant professionals. However, the targets planned for the year 2007 need to be actioned on time. EVIDENCE: The management had appointed a new manager, who reported to duty on the 01/01/2007. The manager was observed to communicate effectively with both service users, staff and appeared approachable. Service users and staff who were spoken to supported this view. The home had an inclusive atmosphere. The management had developed and introduced a new set of internal monitoring tools. These tools are designed to be used by the staff on all the shifts, which were comprehensive that covered areas of personal care, daily activities, medication, appoints with professionals including health. Water 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 21 temperature record checks were seen on this inspection and found the temperatures recorded were with in the safety limits. The manager informed on this inspection that the service users’ do not access laundry on their own, with out the support of the staffs on duty. Developing and maintaining an effective quality assurance system within the home, was set as a requirement at the last inspection. Quality audit was carried out for the year 2006 and an action plan was prepared for the year 2007. The management had also presented a document that covered quality targets and monitoring for the period 2007. This performance management tool was designed in response to the national minimum standards, which addresses each and every single standard in relation to what is current practice at the home, what is the proposed planed new target for the year 2007 and the status of the proposed target that was expected to be recorded. This new internal monitoring system is expected to be simple and specific that help support improvements and benefit service users’ achieve quality of life goals. However, there were some areas that needed implementation of the targets planned for the year 2007 on time. 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 (2b) & (2c) Requirement The home must complete six monthly care plans reviews and update care plans of all the service users’. (Previous timescale 30/03/06, 31/10/06 partly met). Each service user must be provided with an individual written contract or statement of terms & conditions, which must be signed by the management and the service user or their representative. (Previous time scale 31/10/06 partly met). Timescale for action 31/05/07 2. YA5 5 (1b) & (1c) 31/05/07 3. YA9 13`(4a,b, c) & 15 (2b) Risk assessments must be 31/05/07 reviewed by the home at appropriate and agreed intervals. (Previous time scales 31/10/06 partly met). The home must ensure that all the staffs’ records are at all times available for inspection. 31/05/07 4. YA34 17 (2) schedule 4 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 72a Broad Street House 1 DS0000014884.V337261.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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