Inspection on 22/11/05 for Abba Care Home

This inspection was carried out on 22nd November 2005.

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 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

Abba Care Home 04/12/08

Abba Care Home 24/09/07

Abba Care Home 13/10/06

Abba Care Home 23/05/05

Abba Care Home 14/03/05

Abba Care Home 10/05/04

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Sunny Bank (P.R.S.) Ltd

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Thornton Lodge

Alfred House Residential Care Home

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Fernhaven

Thames House

Creative Support

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Abba Care Home Wesley Old Hall New Row Weir Bacup Lancashire OL13 8RA Lead Inspector Mrs Christine Mulcahy Unannounced Inspection 22nd November 2005 10:00 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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. Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Abba Care Home Address 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) Wesley Old Hall New Row Weir Bacup Lancashire OL13 8RA 01706 879042 01706 879565 Mrs Rosemarie Nash Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (4) Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Statement of Purpose, Service User`s Guide, written policies and procedures and all administrative tools and record systems of the home must be reviewed, and revised where necessary, to reflect the change of name. The home is registered for a maximum of 4 service users to include: up to 4 service users in the category of MD (mental disorder under 65 years of age excluding learning disability or dementia) up to 4 service users in the category of MD(E) - mental disorder over 65 years of age, excluding learning disability or dementia. 23rd May 2005 2. Date of last inspection Brief Description of the Service: Abba Care Home is registered with the Commission for Social Care to provide care and accommodation for 4 service users with a mental disorder. The property is a detached house set in a rural area. It is set back from the road and situated within four acres of fields. It is reached via an unmade road near the village of Weir. The home has views of the surrounding hills and valleys of the Rossendale Way. Accommodation is provided in 3 single bedrooms and one double. Bedrooms are on the first floor of the house. Within the home, there are lounge areas and a kitchen diner on the ground floor. A recreation room is attached to the back of the building. The home has a no smoking policy. Sheep, goats and poultry are kept in the fields attached to the home, and service users who are interested in outdoor pursuits and the care of the animals are encouraged to be involved. The home presents an attractive environment, both in its setting and in the high standard of furnishings, decoration and cleanliness throughout. Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second unannounced inspection in 2005. The inspection took place over one day. The service was inspected against the National Minimum Standards for Older People and National Minimum Standards for Younger Adults involved examination of records and discussion with 3 service users. There are references to the case tracking process. This is a method where the inspector focuses on a small representative group of service users. All records pertaining to these people are inspected along with the rooms they occupy in the home. Observations are made of the care provided and the service users are invited to have a discussion with the inspector to discuss their experiences of life in the home. Breaches in regulations and standards that pose an immediate risk to service users have been highlighted for urgent action. The inspection was carried out with the co-operation of the registered manager. Over the course of the inspection the inspector spoke to 3 service users, 1staff members, and the responsible individual. A tour of the premises took place including all bedrooms. Documents were read and care observed. What the service does well: What has improved since the last inspection? At the last inspection medication was not managed or stored well enough to ensure service user safety. However medication is now stored in a locked metal cabinet that is accessed only by a designated member of staff. Due to these improvements medication was being handled according to the relevant Acts and Regulations. Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 6 Aided by a risk assessment service users are better supported to administer and control their own medication through a risk management framework. What they could do better: 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. Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1, 2, 3, 4, 5, 6 and YA 1, 2, 3, 4, 5. Service users admitted to the home are referred after assessments through the Care Management process. These assessments formed the basis of the agreed care plans. EVIDENCE: The specialist services provided at the home are for people with mental health problems. The Care Management Assessment included information regarding ongoing health and welfare issues that required the continued involvement of other professionals and key workers (such as a Community Psychiatric Nurse). Case tracking showed that the registered person had ensured that the appropriate links had been established and contacts maintained. Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 9 Service users were provided with a contract setting out terms and conditions of their occupancy and fees to be paid. The registered person provides service users with personal care, as identified in their care plan, and makes necessary arrangements for service users to access dental, optical and chiropody treatment as required. Case tracking confirmed this. The home does not provide intermediate care Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8, 9, and 10 YA 6, 9, 16, 18, 19, and 20 Service user care plans were based on the Care Management Assessments and were reviewed and revised frequently. Service users were treated with respect and their privacy was upheld. Risk assessments were available for a number of activities to safeguard service users from harm. . EVIDENCE: The family living experience offered at the home meant that service users had the opportunity to express their preferences in matters of daily living, such as what time they get up or go to bed, choice of food and how they spend their Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 11 time. Service users live alongside the registered person and her husband and have meals together therefore there is plenty of opportunity for informal discussion. Case tracking confirmed that risk assessments were undertaken as part of the initial and ongoing assessment processes. These were reviewed and revised according to circumstances. House rules, agreed by service users, to minimize risks were apparent and a smoking area was available in a purpose built hut outside of the house. A written policy on confidentiality was available to service users. The policy made it clear that information would not be shared with family or friends against their wishes. The local pharmacist now dispensed medicines in dosettes. These were stored in a locked metal cupboard that could only be accessed by designated staff. Medication administration record sheets were signed by staff to confirm medicines had been administered. A risk assessment was now available for the service user who self-administered his insulin by injection. When asked, the service user confirmed that the registered manager continued to check the procedure to ensure he was not at risk of harming himself. Another service user at risk from wandering away from the home now wears an identity wrist bracelet. The bracelet holds information about the identity of the service user including name, address, and the person to contact in case of emergencies. A copy of the service user risk assessment was not available at the time of the inspection therefore the inspector required a copy of this to be sent to the Commission. Case tracking confirmed that service user reviews were held frequently. One service user review took place bi-monthly and the community psychiatric nurse attended. The two other service users each received three monthly reviews. Written notes and records were examined and confirmed this. Case tracking confirmed that general service user information was recorded in a daily diary logbook that could be accessed by all staff. Information like meals served and eaten, activities, and appointments were recorded. Service user personal information was recorded in individual service user files. Service users’ individual records were kept securely in a recently purchased locked cabinet. The registered manager commented that files were more accessible to staff whom now felt encouraged to contribute to care plan records. Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12, 13, 14, and 15 YA 12, 13, 15, and 17 Service users were encouraged to maintain their social interests in and out of the home. Service users received good wholesome food in a homely environment. EVIDENCE: Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 13 Currently all service users in the home are aged over 61 years and non are employed. The inspector was satisfied that if a service user needed help from staff to find and keep an appropriate job, continue their education or training assistance would be provided. Service users are also helped with transport because of the homes location and practical problems of transport and access. Case tracking demonstrated that service users are assisted with finance and benefits issues r appropriate professionals including solicitors. Service users were encouraged to take part in activities inside and outside the home. One service user enjoyed looking after the animals and devoted a lot of his time to their care and feeding. Another service user enjoyed short walks around the home and the registered person had planned regular accompanied walks to meet the service user needs. Leisure activities were available in the home including books, television and videos. Service users were seen watching television at some points during the inspection. There was a recreation room with pool, table tennis and darts available. Service users went out with staff, both locally and on day trips. The registered person stressed that she makes a point of providing at least one day a week out of the home for day trips. One service user spoken to confirmed they had recently returned from a long weekend in Blackpool where they holidayed with the registered person. Service users are encouraged to maintain family and community links wherever these have been identified. Case tracking showed that service users friends and relatives were invited to visit the home at any time. Facilities within the home allow service users to see people in private if they want, as there is ample space for privacy when required. Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was assessed at the previous inspection. The inspector was satisfied that all standards in this section were unchanged and met with the requirements of each standard. EVIDENCE: Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19, 20, 21, 22, 23, 24, 25, 26 and YA 24 and 30 Service users lived in a safe and well-maintained and comfortable environment. The home is clean pleasant and hygienic. EVIDENCE: The home provided a comfortable and relaxed atmosphere. Accommodation was provided in 3 single bedrooms and one double bedroom. Communal space includes a recreation room. The premises were safe and well maintained. All areas were well furnished, attractively decorated, and clean. Since the last Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 16 inspection, new furniture had been purchased for the lounge areas and new storage for medicines and personal files. The home was approximately 10 minutes walk by an unmade road from the main road where a bus service ran every 2 hours. The Registered Provider provided transport for service users to access various activities out of the home. Service users have exclusive use of a bathroom, with bath and shower facilities, and a toilet with a wash hand basin. These facilities are easily accessible to their personal bedrooms and are situated directly opposite the bedrooms. All utilities are domestic in style with appropriate privacy locks. Additional toilet facilities are available within the home – one being off the small lounge area, and the other being through the recreation room. There were three comfortably furnished communal areas, all with television. A paved terrace and garden area with seating is provided at the back of the house, with views of the fields and accommodation for the animals. Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27, 29 and YA 34, 35 There was enough staff on duty to meet the service users needs. Recruitment procedures to ensure service users were protected from harm had not been followed thoroughly. EVIDENCE: The staff rota was examined and met with the requirements of the previous registering authority. When asked service users said they were happy with all of the staff and felt they were in safe hands. Case tracking of staff confirmed that a recent employee had been employed without an up to date CRB check. The registered manager was required to remove the employee from the staff rota until she received satisfactory results of an enhanced CRB check and all other relevant documentation required. Staff training was ongoing and the registered manager had now gained NVQ level 4 in care and a Registered Managers Award. Other staff were updating their qualifications in 1st Aid, food hygiene and medication handling. Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 18 Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not assessed on this occasion. EVIDENCE: Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 N/A 17 N/A 18 N/A ENVIRONMENT Standard No Score 19 3 20 3 21 3 22 3 23 3 24 3 25 3 26 3 STAFFING Standard No Score 27 3 28 N/A 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 N/A 32 N/A 33 N/A 34 N/A 35 N/A 36 N/A 37 N/A 38 N/A Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 21 NO 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 YA6OP7 Regulation Requirement Timescale for action 05/12/05 2. YA34OP29 Reg 13 The registered manager must (4) (a,b,c) ensure that information relating to the health and safety and wellbeing of service users is included in service user care plans in the form of a risk assessment. Please forward a copy of the risk assessment to the Commission by the date shown Sch 2 The registered person must Reg7,9,19 ensure that information in respect of people working in the care home is kept up to date. All new employees must have a satisfactory enhanced CRB and POVA 1st check prior to appointment. Please advise the Commission of the steps taken to meet this requirement. 22/11/05 Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 22 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 Abba Care Home DS0000009594.V269978.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI. 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