Inspection on 22/09/08 for 9 Grace Road

This inspection was carried out on 22nd September 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

9 Grace Road 31/10/07

9 Grace Road 08/06/06

9 Grace Road 29/09/05

9 Grace Road 24/05/05

9 Grace Road 16/11/04

9 Grace Road 04/05/04

Similar services:

Hillside

Applegarth

Trevayler Residential Care Home

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 9 Grace Road Leicester LE2 8AD 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: Keith Williamson Date: 2 2 0 9 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 Inspection report CSCI Page 2 of 29 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Robert Philip Tweddle Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 2 17 7 17 6 0 0 0 0 0 care home 17 9 Grace Road Limited 9 Grace Road Leicester LE2 8AD 01162331035 01162331005 tweddle7@aol.com dementia learning disability mental disorder, excluding learning disability or dementia physical disability sensory impairment Additional conditions: No person to be admitted to the home in categories LD/MD when 7 persons of categories LD/MD are already accommodated in the home. No person to be admitted to the home in categories LD/MD when 7 persons of categories LD/MD are already accommodated in the home. No person falling within category PD, SI, MD or DE may be admitted to the home unless that person also falls within the category LD I.e. multiple disability . No person to be admitted to the home in categories LD/SI when 6 persons of categories LD/SI are already accommodated in the home. No person to be admitted to the home in categories LD/SI when 6 persons of categories LD/SI are already Care Homes for Adults (18-65 years) Page 4 of 29 accommodated in the home. No person to be admitted to the home in categories LD/DE when 2 persons of categories LD/DE are already accommodated in the home. No person to be admitted to the home in categories LD/DE when 2 persons of categories LD/DE are already accommodated in the home. Date of last inspection A bit about the care home 9 Grace Road is situated in a quiet area on the outskirts of Leicester, close to a variety of community amenities and transport links. Care and support is provided to seventeen adults who have a learning disability and associated communication difficulties. Some service users also have physical disabilities, dementia and/or sensory impairment. The communal areas consist of a large, attractive lounge/dining room, two daycare rooms and a sensory room. The home also has a training kitchen where service users can learn cookery skills. Currently all service users are accommodated in single bedrooms. There are two staircases and a shaft lift to access communal areas and bedrooms on the first floor. The home has a specially adapted bath and shower rooms to meet the needs of people with physical disabilities and a large, enclosed garden, which again is fully accessible. Current fee levels range from #700 to #1,909 Care Homes for Adults (18-65 years) Page 5 of 29 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 29 How we did our inspection: This is what the inspector did when they were at the care home The focus of the inspection is on outcomes for Service Users and their views of the service provided. The main method of Inspection used was case tracking which involves selecting a sample number of people and tracking the care they received through talking with them where possible, and looking at their records and accommodation, in this case three Service Users were chosen. This visit took place over one day, commencing at 09.30am and took seven hours to complete. An opportunity was taken to talk with Service Users the registered manager and staff, look around the home, view records, policies and care plans. Information was obtained from the Annual Quality Assurance Assessment, which gives information about the home, and is filled in by the registered manager. The Commission for Social Care Inspection are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. On this occasion a method of working where experts by experience are an important part of the inspection team and help inspectors get a picture of what it is like to use a social care service. The term Care Homes for Adults (18-65 years) Page 7 of 29 experts by experience used in this report describes people whose knowledge about social care services comes directly from using those services. On this occasion the expert conducted a number of interviews to assist in the overall inspection, three people were selected, all of whom were spoken with. The comments made, form part of this report. A copy of the last Commission For Social Care Inspection report is displayed at the homes office, and copies of this report are available from the registered manager. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the care home does well The paperwork required by law, to enable Service Users care needs to be delivered by staff, are completed promptly and give staff instruction on how to care for people safely. This is important as staff can offer care consistently. Some of these documents such as the Service User Guide and complaints information are completed using the easy read format using pictures and symbols. This makes sure that the Service Users needs will be understood and met. Medicines are administered safely, with two staff assisting in the process. Staff were aware of their responsibilities in this area, and when questioned showed a good knowledge of the processes involved. Care Homes for Adults (18-65 years) Page 8 of 29 Complaints information is displayed in the home, and staff were aware of the procedures involved in reporting suspected abuses on behalf of Service Users. Staff are also aware of how the whistleblowing procedure works. This is where staff can report on to external agencies such as the police, if any suspected abuse is not dealt with in an appropriate way. This is important as it suggests staff are aware how to keep Service Users safe in the home. Decisions that the Service Users make are recorded in the daily notes. Service Users time during the week is taken up by college courses or social care time. These and other documents are held securely in the home. This is important as it shows personal details are held in a confidential manor. Prior to staff being employed in the home, a number of checks are carried out, to ensure Service Users safety. The policies and procedures used by staff have been reviewed and the staff numbers are reflective of current Service Users needs. Supervision, which is a meeting between the manager and staff on a one to one basis; and staff appraisals continue to take place regularly. This is important as it forms the basis for planning individual Care Homes for Adults (18-65 years) Page 9 of 29 staff training needs. The home is comfortable and clean, and staff were aware of cross contamination and cross infection issues. Staff complete regular health and safety checks to help keep the home a safe place to live in. Care Homes for Adults (18-65 years) Page 10 of 29 What has got better from the last inspection The care plans are being adapted to a Person Centred Planning format. This shall make the plans concentrate on the peoples individual needs and communicate those to the staff. The issue mentioned in the last report regarding Service Users finances has now been completed. What the care home could do better Some of the flooring in the home needs some attention as the carpet to the main staircase, and flooring in the laundry are unsafe and pose a potential hazard to Service Users and staff. Care Homes for Adults (18-65 years) Page 11 of 29 Service User leisure time could be enhanced and Service Users could be more involved in planning their own menu choices and meals. Drinks could be made readily available to Service Users at all times including meal times, as these were seen to be irregularly supplied by staff. Menus could be produced in a pictorial form, and total communication could be used in the home. This is where staff would include Makaton sign, using symbols, pictures and speech, when communicating with Service Users. Leisure materials could be more age appropriate, assisting in Service Users pastimes being more beneficial and fulfilling. Care Homes for Adults (18-65 years) Page 12 of 29 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 Keith Williamson CPCI Capital Park Fulbourn Cambridge CB21 5XE 01223 771 300 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 Care Homes for Adults (18-65 years) Page 13 of 29 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 14 of 29 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 . A thorough assessment procedure ensures that service users needs are effectively met. Evidence: The service users assessment information was well detailed and contained information relating to their needs and abilities. This is important as this information forms the basis for any plan of care. Some details had been recently updated, these were held together with the assessment documents from the service users placing authority. A contract was also in place. These documents are important to signify the terms and conditions of their stay. Discussion with the registered manager and staff indicated that the assessment process was being changed to a person centred style. This shows the staff are giving more thought to the detail in the assessment process. Care Homes for Adults (18-65 years) Page 15 of 29 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 . Service Users are supported by a well informed staff group, backed up be detailed care plans and risk assesments. Evidence: The Service Users support plan was examined: this like their assessment was well detailed and covered aspects of their daily life. The plan was written in a person centred way, and bore a direct link to the assessment information. This is important and shows the home developing the information needed to care for people. Some people are involved in the composition of their care plan or in the Person Centred Planning (pcps) process. This is down to an ability issue as some Service Users are unable to sign their plan to confirm their agreement with the content. Staff responsibilities for meeting various aspects of the plan were clearly identified and there was evidence that the information was regularly reviewed. The plans were backed up by risk assessments; these giving staff instruction on how Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: to care for people safely. Staff displayed a good understanding as to why this was appropriate. Daily notes cover activities and the Service Users responses. Care Homes for Adults (18-65 years) Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service Users personal development is well recorded in the plans of care. Leisure activities and the meal and menu system could be improved to provide Service Users with more appropriate choices. Evidence: Service Users individual personal development is well detailed in care plans and Person Centred Plans (pcps). Some Service Users attend college though none of the current Service User group are looking toward continuing paid employment. Service Users continue to take part in leisure activities within the home. The report by the visiting Expert by Experience concluded that some of the pastimes in the first floor activities room, were child like and could be replaced with more age appropriate materials. The Expert by Experience also highlighted that all Service Users had to ask to be let into their bedrooms. A suggestion was made that in some cases; Service Users could Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: have their individual bedroom keys on their person. These could be obtained by staff to enable their entry, if unable to operate the key. The Expert by Experience also pointed out that drinks should be more readily available at all times, especially with meals. The planning of meals was another area, where Service Users could have direct input, where currently meals are planned around individual Service Users likes and dislikes. Care Homes for Adults (18-65 years) Page 19 of 29 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 . Service Users health, personal care and medication needs are well met. Evidence: Service Users personal care and support needs are clearly detailed in their care plan; is detailed and indicates likes and dislikes such as which staff members they preferred to receive support from. Service Users also have information in their plan of care, about their health management and have regular access to dental and optical services. Others such as consultant psychiatrists, psychologists and speech and language therapy staff also have individual input. This is important as it shows the home cares for peoples greater health needs. Care Homes for Adults (18-65 years) Page 20 of 29 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 . Service users are protected by policies, procedures and a well informed staff group. Evidence: There have been no complaints forwarded to the Commission for Social Care Inspection with regard to the home. There have been some complaints recorded by the staff, and these have been dealt with promptly, with a good outcome for the complainant. Some of the information recorded in the complaints book, was removed, as it not directly involve Service Users at the home. Complaints information is clearly displayed in the Service User Guide, and will shortly be available in a pictorial version. This would help the current Service Users in making a complaint, though advocates and relatives when appropriate are used in this process. Staff told the Inspector what they knew about the complaints, adult protection and whistleblowing procedures. They showed a good understanding of the process involved in following such issues through. Adult Protection training for the staff is undertaken at regular intervals. Service Users personal allowances are paid into one account, but there are clear paper trails involved to show where individual Service Users monies are held, and what balance is available to them. There have been no protection issues forwarded to the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service users live in an environment that is homely, comfortable and clean, though the conditions underfoot, and cluttered areas have the potential to cause accidents. Evidence: The general decor is. There is currently no maintenance plan, and the areas requiring updating pose potential hazards for Service Users and staff. The Expert by Experience highlighted some areas of concern. There were a number of areas in the home that were cluttered with boxes, storing new items awaiting unpacking. Also that there were a number of electrical sockets that were not covered, and she thought this could leave a potential for an accident. The Service Users bedrooms are personalised, with various pictures furniture and electrical equipment. Staff were aware of cross contamination and cross infection issues, and agreed that there were plentiful supplies of protective clothing. This is important to protect Service Users and staff in the home. Care Homes for Adults (18-65 years) Page 22 of 29 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 . Service Users are supported and protected by well-trained staff and effective recruitment practices. Evidence: Staffing levels reflect the Service Users level of need and enable individual support throughout the day and night. A comprehensive programme of training is in place. Staff spoke positively about the training opportunities and the ongoing, individual support that they receive. Training is sourced from private and public providers. Staff recruitment records were examined; these were up to date and in order. These contained a written application form, two written references and evidence of identity. Discussion was held about Criminal Records Bureau checks and the delay currently experienced with these being processed. Staff supervision is undertaken regularly, and assists the Manager plan the appropriate staff training plans. This is important as it means staff are viewed on an individual basis, and the appropriate training planned accordingly. Care Homes for Adults (18-65 years) Page 23 of 29 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 . Well developed management systems, and well informed staff ensure that Service Users and staff health and safety is promoted. Evidence: The current registered manager has been working at the home for some years, and is qualified and experienced to run the home. Service Users and relatives have the benefit of a staff photograph board with staff members name and job title is displayed. This assists with staff recognition, so visitors are aware who they are speaking to. Staff have regular supervision and appraisal sessions. These provide the manager with a clear sense of where staff have training development needs, allowing the targeting of resources to particular training courses. There are currently no recorded visits from the Responsible Individual, though he currently visits on a regular basis. It is important if the number and frequency of these visits diminishes that proper records of the visits and what is overseen are completed and made available at inspection. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Areas of risk are assessed appropriately, and these are updated regularly. This is important as it increases the safety for Service Users and staff in the home Evidence of some of the Quality Assurance with questionnaires sent to relatives, little or no work with current Service User group, to look at pictorial system for Service Users. Policies and procedures are up to date; some were reviewed following the visit. This shows the home is working with the Commission for Social Care Inspection in raising the levels of safety for the Service Users in the home. Health and safety is good, with staff completing tests on the fire system, hot water and fridge temperatures on a regular basis. The fire risk assessment and escape plan were not seen on this occasion and shall be viewed on the next visit. Staff were able to explain how often fire drills took place, and what was required to happen if the fire alarm sounded. The insurance certificate was noted to be in date. Care Homes for Adults (18-65 years) Page 25 of 29 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 1 6 15 Service users? plans must detail how to meet service users? identified needs and be written in a format that ensures they are accessible to care staff and where possible, service users. 31/01/2008 2 23 12(5) The registered person must 31/01/2008 encourage and assist staff to communicate with service users in a manner, which maintains the service users? dignity and promotes an appropriate personal and professional relationship. 3 39 24 The registered person must 30/04/2008 establish and maintain a system for evaluating the quality of the services provided at the care home, which takes into account the views of service users and their representatives. Care Homes for Adults (18-65 years) Page 26 of 29 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 1 30 23 The condition of carpeted 20/11/2008 areas, and those in the laundry leave the potential to place Service Users and staff in danger. Replacement of these areas is required to keep Service Users and staff safe in the home. 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 1 6 Service Users who can particpate in the care planning process, and are able to sign their plans, should be encouraged to do so. this would ensure they agreed to the care being offered. Leisure materials could be more age appropriate, assisting in Service users pastimes being more beneficial and fulfilling. 2 14 Care Homes for Adults (18-65 years) Page 27 of 29 3 4 17 17 Drinks could be made readily available to Service Users at all times including meal times. All menus could be in a pictorial form. Service User could be more involved in planning their own menu choices and meals. Total communication could be used in the home. This would include Makaton sign, using symbols, pictures and speech. 5 17 Care Homes for Adults (18-65 years) Page 28 of 29 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. 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. 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