Inspection on 27/01/09 for Beechlawns

This inspection was carried out on 27th January 2009.

CSCI found this care home to be providing an Adequate 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

Beechlawns 28/01/08

Beechlawns 16/05/07

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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: Beechlawns 20 Wood Street Wollaston Stourbridge West Midlands DY8 4NW     The quality rating for this care home is:   one star adequate 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: Sally Seel     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 40 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 Information about the care home Name of care home: Address: Beechlawns 20 Wood Street Wollaston Stourbridge West Midlands DY8 4NW 01384835050 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Select Health Care (2006) Limited care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 7 The maximum number of service users to be accommodated is 7. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD 7) Date of last inspection Brief description of the care home Beechlawns is a large detached property located in the Wollaston area of Stourbridge. It is situated in a quiet residential area and is within walking distance of the local village, which has numerous shops, public houses and other local amenities. The town centre of Stourbridge can be accessed by public transport. There is a small car parking area at the front of the property. The gardens are situated to the rear and side of the property. There is a ramp leading to the front door and into the garden. The Home was initially registered in 1993 to provide care for seven adults with learning disabilities. Resident accommodation is on the first and ground floor. The Home has a stair lift. All users accommodated on the first floor are fully mobile. There are seven single bedrooms. Residents bedrooms are all decorated individually and reflect residents differing tastes and personality. Residents can bring some of their own furniture if they Care Homes for Adults (18-65 years) Page 4 of 40 Brief description of the care home wish. The Home has two bathrooms one with separate walk in shower. There are toilets located on the ground and first floors. There are two lounge areas and a dining room. Beechlawns provides care for residents with a range of learning disabilities and with complex communication, mental and health care needs. A statement of purpose and service user guide are available to inform residents of their entitlements. To obtain up to date fee information the home will need to be contacted. Care Homes for Adults (18-65 years) Page 5 of 40 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: one star adequate 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 peterchart Poor Adequate Good Excellent How we did our inspection: The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. One inspector undertook this fieldwork visit to the home, over an eight hour period. The support manager and staff members assisted us throughout. The home did not know that we were visiting on that day. There were four people living at the home on the day of the visit and the inspector arrived before people living in the home had left for the day. Care Homes for Adults (18-65 years) Page 6 of 40 Information was gathered from speaking to and observing people who lived at the home. Two people were case tracked and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records, health and safety documentation and Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. Also two staff surveys were completed and returned to the Commission for Social Care Inspection, (CSCI). Information from both these sources was used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking two individuals care provided at the home. For example, the people chosen have differing communication and care needs. The people who live at this home have communication needs that meant discussions with them could not take place and/or some people chose not to speak with the inspector. In view of this we spoke to staff on duty in order to find out about the support people receive. The atmosphere within the home is inviting and warm and we would like to thank everyone for his or her assistance and co-operation. What the care home does well: What has improved since the last inspection? Statement of purpose and service user guide have improved in relation to confirming what fees the home charges for people to live there. Also these information guides are in pictorial formats so that they can be accessed by all people. Some staff have received training in developing communication passports so that individuals in the home can be enabled to make their preferences known so that their lives are meaningful to them. There is a more robust programme of training in safeguarding with all staff being given the opportunity of attending adult protection training with further dates for abuse awareness and protection of vulnerable adults taking place in March 2009. This means that people living at Beechlawns are protected by knowledgeable staff that have a good understanding of issues arising out of differing types of abuse. Care Homes for Adults (18-65 years) Page 8 of 40 The homes environment is continually improving in relation to redecoration and new furniture that has been purchased in some areas so that people live in an environment that is well maintained. The home are no longer employing agency workers which means that people living at Beechlawns will be consistently supported by trained staff who are familiar to them. At the random inspection undertaken on the 31 March 2008 we found that the home had met their two outstanding requirements that had been made at their last key inspection on the 28 January 2008. These were around fire risks and the management of peoples finances. This shows that people are offered greater protection in both of these areas. What they could do better: Statement of purpose and service user guide should be regularly maintained and updated, (at least annually), to ensure all services provided by Beechlawns can be seen together with any changes. Care plans need to be easily linked to risk assessments to ensure that these are not confusing for staff to follow and do not place individuals at risk. Care plans need to be further developed to ensure that they are person centred so that individuals are assured that they receive care and support in a way they prefer and at times suited to them. Communication aids including communication passports need some further development and these need to be put into practice by all staff so that people living at Beechlawns are confident that staff will be able to interact with them ensuring choices, respect and rights are upheld appropriately. Progression needs to be made in relation to ensuring that people at Beechlawns are supported to participate in activities that are meaningful to them as individuals and enhance life skills, such as, making drinks, preparing meals and so forth. Staff need to record individuals fruit and vegetable portions to ensure that people are being offered five a day as per the recommended amount to sustain a healthy and nutritional diet. Individual health care plans must be developed and show that peoples needs are met and their health is promoted. The home must review its current practices in respect of checking on people through the night time period and risk assessments must be in place that states the reasons for these checks and for what purpose. This process needs to be completed in a multidisciplinary forum so that decisions made are in the best interests of the individual concerned. Regular weight checks need to be maintained so that any losses or gains in weight can be observed as this could detect underlying health issues that may otherwise go Care Homes for Adults (18-65 years) Page 9 of 40 undetected. All prescribed creams/lotions must be stored appropriately in lockable facilities to protect all individuals who live in the home from harm. The home must sensitively develop end of life care plans for people living at Beechlawns so that care and support received at this time is delivered to an individuals meets their preferences. To increase staff training in developing communication passports so that individuals can be supported in enhancing their quality of lives with the help of a staff team who are able to interact and understand them. A structure for capturing and recording both formal and informal complaints/issues/compliments should be implemented that would promote a culture of openness within the home and a proactive approach to identifying and addressing concerns. All complaints must be recorded appropriately so that people living at Beechlawns can be confident that their views and concerns will be listened to and acted upon with a clear audit trail that recognises this practices takes place. To take advice from an occupational therapist in relation to developing individuals levels of independence particularly due to the physical layout of the home. This will ensure that people living at Beechlawns are able to access all parts of the home if they choose to participate in activities that relate to that area. Keyworker meetings now need to take place on a regular basis and these need to be sustained so that individuals have the opportunity of sharing any concerns and/or issues they may have on a one to one basis. The home must review its key holding practices in relation to having access to individuals monies at all times so that peoples choices and rights are maintained in this area. All information in the AQAA must be accurate with clear examples of practices so that the home can be seen to be open and transparent to ensure that it is run in the best interests of people who live at Beechlawns. The home must continue to develop their quality assurance systems to provide an analysis of the views of people who live there together with their family members and stakeholders. This will ensure that the home are listening and acting upon any improvements that can be made to its procedures and practices to achieve good outcomes enriching the lives of the people who live at Beechlawns. 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. Care Homes for Adults (18-65 years) Page 10 of 40 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 11 of 40 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 12 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to ensure that the information provided to people considering living there is updated and therefore individuals decisions are based upon factual information that has been provided by the home. Individuals care needs are assessed and risks identified but these are not necessarily linked so that personalised care is promoted in the way people prefer and at times that suit them. Evidence: The home has a statement of purpose and service user guide. However, when we asked two members of staff to show us these they did not know where to find them. Therefore we recommend that all staff are aware of where both the statement of purpose and service user guide can be located in the home so that this information can be accessed at all times. It was positive to see that the statement of purpose and service user guide have been improved since the homes last inspection. They are now provided in written word and pictures used so that the information provided is able to be read and shared by all people considering living at Beechlawns. The information within both of these guides, tells people what the homes environment is like, what the Care Homes for Adults (18-65 years) Page 13 of 40 Evidence: home can offer together with details regarding the complaints procedure and the fees charged. We found that some of the information was not correct both in the statement of purpose and service user guide. For example, the previous managers name is documented and the fees charged by the home in the pictorial statement of purpose has another homes name linked to them. Therefore the home must review their statement of purpose and service user guide to ensure that information is factually correct so that people considering living there are not mislead. Also the home has an old inspection report, dated 16th May 2007, held with their preadmission information which is situated by the homes front door. We now urge the home to replace this old inspection report with their up to date report. It is recommended that the home reviews their statement of purpose and service user guide, at least annually; this will ensure that individuals can see that they have updated information and staff are reminded of the aims and objectives that they are working to. There have been no new people admitted to the home since their last inspection. Therefore, the standard relating to assessment of new people was not fully assessed on this occasion. There are currently four people living at the home, three males and one female. We sampled two individuals care plans which show what people need assistance with in their everyday lives together with the risks so that staff can ensure that individuals needs are met safely. However, care plans and risk assessments are not linked making it difficult to gain a good understanding of meeting individuals needs and staff acknowledged this. Therefore people living in the home may not have their individual needs met in a preferred way or at a time they would like. Also care plans are not personalised so that recognition is given to each persons abilities and strengths. This is looked at in more detail in the section on care planning. Staff surveys told us:Cares for individuals well, staff very caring. The home is clean and tidy and the staff are caring. Employ more staff. Care Homes for Adults (18-65 years) Page 14 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements have been made in relation to developing aids to enable staff to communicate with people who live in Beechlawns but these need to be used consistently by all staff. There is written information to guide staff in supporting peoples individual needs, although care plans and risk assessments need further development to ensure they are personalised and are easy to follow by all staff so that individuals are supported in a safe manner. Evidence: The care records of two people who live at Beechlawns were sampled. Records included an individual care plan. These state how staff are to support the person to meet their needs and achieve their aspirations. Since the homes last inspection these have not been further developed to ensure that they are easy for staff to follow and person centred. For example, we found no information within the two care records that we sampled of people living in the home and or their representatives being included in any of the care plans to ensure that individuals abilities and strengths are being Care Homes for Adults (18-65 years) Page 15 of 40 Evidence: promoted. We were assured by the support manager that the home have made a start on developing individual care plans which can be easily linked to risk assessments. However, we could not locate these in any of the care records we looked at. This means that staff do not currently have access to these care plans so that they can be followed whilst providing support and care to people. We found that care plans have been reviewed but this needs to be done consistently and regularly with the individual present and or their representative so that people are enabled to express their views and preferences which may change over time. Care records sampled included individual risk assessments. These state how staff are to support individuals to minimise risks in relation to administration of medication, managing finances, behaviour, self help and independence, activities and outings. However, as already risk assessments could not be easily cross referenced to risk assessments so that staff can be clear how to support each person safely. This continues to be outstanding from the homes last inspection. Improvements must be made in this area to ensure staff are able to easily access these without any confusion arising to ensure risks to individuals are not only identified but also managed safely. Daily records are completed for each person living at the home. These give an insight into a persons routine each day, their state of wellbeing and any appointments they have attended. Additional care should be taken to ensure these are completed providing enough information which should include reasons for individuals declining any meals, activities offered and participated in so that staff on all shifts have this information. People living at Beechlawns have a range of needs including communication, behaviour and sensory. We observed staff trying to establish what one individual wanted to do, whether they wanted to remain seated at the table or go to sit with others in the lounge area of the home. Staff seemed to have to some difficulties in trying to establish this persons own preferences. Therefore it is recommended other forms of communication be explored, such as, the use of photographs, pictures and objects of reference in order that all individuals can be involved in decision-making processes. Positively, two staff members who came on shift in the afternoon confirmed that they have recently been on training courses provided by the speech and language therapist, (SALT). However, this approach to understanding individuals communication and ensuring barriers are broken down was not evident in staff practices in the morning. The two staff members are in the process of developing communication passports for individuals living in the home and this is an improvement since the homes last inspection. Staff showed us the two books that they had started work on for people that they provide care and support to. These were detailed and told a story about the persons life, likes and dislikes with photographs included. These will enable staff to Care Homes for Adults (18-65 years) Page 16 of 40 Evidence: interact with the individual and communicate in a way they will understand. Also some of the information can be placed in care plans that are being developed so that staff are able to meet individuals cultural needs relating to communication, diet, music, contact with family and their religion. People living in the home will eventually be able to carry their own books on their person when in the home and community which will enable them to make choices and decisions about their lives. Care Homes for Adults (18-65 years) Page 17 of 40 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. Generally, people living at Beechlawns are supported to participate in activities and social occasions but these are not always meaningful to the individual or promote life skills. Generally meals are varied but to fully support nutritional needs are met, records should be more detailed particularly in relation to portions of fruit and vegetables that are offered daily. Evidence: We spoke to staff and examined care records and found efforts are being made to support people with activities in the home and community. For example, since the last inspection we were told that people living in the home have been on holiday to Blackpool in October 2008 and a further holiday is to be planned this year. We also found that people were supported to go shopping, rides in the minibus, fetes at the home and social gatherings at pubs. We were told that the home also encourages Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: people to take part in celebrations throughout the year, such as, birthdays, Valentines Day, Easter and Christmas. Staff spoken with confirmed that they give up alot of their own time to support and arrange activities. This year staff are planning to support and encourage people to be involved in seed growing and tending the raised beds in the homes garden area. However, there needs to be some improvement in relation to people having the opportunity to undertake activities and or follow interests individually. We did not find any information in peoples care records that would support this apart from one individual going to a day centre three times a week. Staff told us:- We celebrate occasions, Easter with bonnets, summer fetes with stalls and barbecues. We visit local shopping centres and have our own minibus. On the day we visited we were told that no activities were planned for the day as one person was unwell and staff were awaiting a doctor. However, the support manager came to the home to assist with the inspection and this enabled staff on duty to support two individuals to go to the shops which they seemed to enjoy. The home has forms for recording activities but we could not find these completed on the care records that we sampled. We were shown one of these which was in the office area but was generalised and not individualised. We also found a tick box form completed which highlighted a persons activity preferences but this had not been reviewed since 2007. Therefore it is recommended these be used for recording and evaluating activities in order that the home can monitor that activities meet individuals expectations. There have been some improvements made in relation to the homes environment which has been redecorated and new furniture bought in certain areas which are discussed further in the environment section of this report. However, the layout of the home does not always promote individuals independence due to the style of the building. For example, there are steps down to the kitchen area and the laundry room is located in the cellar with steps down to it. We spoke with staff and they have been trying to encourage more participation from individuals in relation to gaining important life skills, such as, people being supported to bake cakes and placing their laundry in a basket ready for washing. It was concerning to observe the step to the kitchen area but staff have reassured us that people living in the home are able to access the kitchen area without support and a grab rail has now been placed by the kitchen door as an aid. It is acknowledged that people living in the home would not be able to access the laundry room to participate in washing their clothes. The home will now build on promoting individuals independence within the home by gaining advice from an occupational therapist for any suggestions and or ideas in relation to the outlay of the building. This is a recommendation that remains outstanding from the homes last inspection. Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: We sampled the menus and found that meals were varied. The home have improved access to choices for people by ensuring that all menus are in pictorial format so that people can make choices and decisions around their meals. As recommended at the homes last inspection we found no evidence that people living in the home are supported to shop for their meals so that this life skill is developed. Two meal choices are offered at each meal throughout the day and we were told that individuals can be spontaneous with their meals if they do not like the two choices on offer they are supported in relation to alternatives. This is also confirmed in the AQAA, Service users have more choice each mealtime and if what is available to them is refused they can then request what they would like to eat. Also we were told that the home have introduced a variety of new meals to people living there, such as, curries and chillies so that individuals can try to new foods to see if they like them which was a recommendation made at the last inspection. The home does keep a record of what people eat throughout the day but this needs to be improved to incorporate what portions of fruit and vegetables individuals have each day together with a note if people decline. This will ensure that peoples diets contain their recommended five portions per day to maintain healthy diets. Care Homes for Adults (18-65 years) Page 20 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to health care within the home and the local community. Efforts now need to be made in completing health action plans ensuring individuals health needs are monitored and met effectively. The management of medication is good which ensures people get the right medication at the right time. Evidence: We observed that staff had paid attention to each persons personal care; people were wearing clothes in good condition suitable to their age and gender. We were told that people living in the home are able to choose whether they prefer assistance with their personal care tasks from either a female or male. This positive practice promotes individuals choices and dignity. People living in the home have key workers and they assist people with choices, outings and any health issues that come to light. However, there needs to be more work undertaken in respect of the knowledge to be gained in respect of meeting the needs of people who are growing older. Improvements in this area will ensure that staff are confident in age related illnesses and the changing physical needs of people. Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: This should also include end of life care plans so that individuals can be reassured that their practical, physical, emotional and spiritual needs will be managed in a way that people prefer at this time in their lives. These care plans will be particularly important as one person who lived at the home died recently and we only found one care record that confirmed a persons funeral wishes in picture format. As mentioned earlier in this report care plans and risk management systems must be improved. This also applies to care planning for health needs. For example, the home must complete health action plans for people so that their health needs are promoted together with any actions required from any medical professional. We were shown that the home have now obtained health screening documentation which are going to be photocopied for every person who lives at Beechlawns. These will then be completed in all sections so that when read they will tell staff and other professionals any health conditions that individuals experience together with how these are met. It is recommended as with care plans and risk assessments the home completes these health plans with individuals and or their representative and appropriate medical professionals. This will ensure accurate plans are developed, individuals health needs are managed and individuals are able to be part of any decision making processes. For example, one person who lives in the home is checked through the night. However, staff could not fully explain the reasons why this individuals needs to be checked through the night other than they have a catheter. We were also told that staff complete regular checks during the night for all individuals who live in the home but we could not find any documentation to confirm exactly why this practice needs to be ongoing or when it was reviewed. Therefore as at the previous inspection we urge the home to review this practice within a multi-disciplinary forum to ensure that individuals rights to privacy is not encroached upon. In the care records we looked at we found that individuals had been supported to attend general practitioner appointments, and on the day of our visit one individual was poorly and their doctor was contacted. Weight records showed that people had not been weighed regularly. It is important that this is maintained. If a person declines then the home should make a decision as to whether they need advice from the individuals doctor, as we noted that on one of the care records we looked at, this had been the case. If someone loses or gains a significant amount of weight this could be an indicator of an underlying health need and so it is important that their weight is regularly monitored. This is particularly essential for people who have limited communication and would not be able to express if they are unwell. Medication is stored in a locked cabinet. The medication is supplied by the pharmacist Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: in blister packs using the monitored dosage system, which makes it easier for staff to know what medication to give to the person and when. Medication Administration Records (MARS) had been signed appropriately and these cross referenced with the amount in the blister packs indicating that medication had been given as prescribed. We were told that one person is prescribed cream on occasions and we found this in the locked cabinet which was not opened. However, this persons cream is also kept in their bedroom on show. The home must ensure that all prescribed medication creams and or lotions are kept in the locked cabinet as people do not have lockable facilities in their rooms. This will ensure that individuals are not placed at risk by the homes medication procedures. Also the cream must be dated when opened with a description of the part of the body that the cream should be applied to for all staff to follow. Some people are prescribed PRN (as required) medication and individual protocols were in place that stated when, why and how much of the medication should be given to ensure that it is given only when needed. For example, in one care record it stated, if complains of pain talk with X and offer a drink, if complains after 10 minutes, administer 2 tabs, monitor and observe and if pain continues report to GP. We also found a PRN protocol for managing behaviour that may challenge and it was positive to see that prior to any medications being given guidelines were in place for staff to try. For example, assess X behaviour, try to divert X by chatting or cup of tea/squash, if behaviour continues allow X 10 mins to their self and tell X youll come back in 10 mins. It was unclear from the care records when this PRN medication was last reviewed we could only find one date in 2007. We therefore recommend that the home clearly documents all reviews of PRN medications and that these are easy to retrieve for checking and monitoring purposes. Positively, PRN protocols are also stored with MARS so that staff have easy access to these. The homes training matrix indicates that three senior staff and the deputy manager have received training in safe medicine handling and this means that people who live in the home are protected from unsafe medication practices by staff who have the necessary understanding. We were told that competency assessments are currently being introduced. Care Homes for Adults (18-65 years) Page 23 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A proactive approach to documenting complaints needs to improve to reflect how the home manages complaints. Staff have the skills necessary to protect people from abuse and know when incidents need to be reported. There are positive attitudes amongst the staff team towards protection matters. Evidence: An easy read complaints procedure is available to each person who lives at Beechlawns making it more accessible for people with communication support needs. This included the relevant and required information so it was clear how people could make a complaint if they are unhappy with the service provided at the home. The levels of learning disability of most of the people living in this home indicate that they would require a great deal of support or advocacy to ensure their rights are protected. Therefore the one to one time that people have with their keyworkers must be sustained so importantly individuals are able to comfortably raise any concerns and or complaints knowing these will be listened to and action is taken appropriately. The AQAA stated, We have not received any complaints requiring investigation within the last 12 months any small issues have been dealt with efficiently by staff to prevent them escalating. Although, in the data collection of the AQAA it is confirmed that the home have received two complaints in the last twelve months. We were shown the book that the home uses to record any complaints and were told there were none Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: logged but the AQAA confirms that, All complaints are logged on a complaints log, but we could not find this evidence. Positively, staff spoken to on the day of our visit were able to confidently explain how they would deal with any complaint and how to ensure people had the support to do this. However, the recording of all complaints must become common practice in the home. This will ensure that an audit trail can be maintained and outcomes for people who live at Beechlawns can be further improved where peoples views and rights are fully protected by the homes recording procedures. In the AQAA it is confirmed that there have been no incidents of alleged or actual abuse reported. Staff members spoken to on the day of our visit were able to describe the actions that they would take if they witnessed any form of abuse. The training matrix highlights that all staff have received adult protection training and we were shown a further schedule of dates for abuse awareness including Protection of Vulnerable Adults, (POVA), in March 2009. Also all staff have received training in Deprivation of Liberty Safeguards, (DOLS), which is linked to the Mental Capacity and is to be implemented in April 2009. This shows that management and staff are now being proactive within this area as at the homes last inspection this was made a recommendation to ensure staff are trained appropriately to be able to be confident when protecting people from the risk of harm. We were unable to examine individuals monies that are held on their behalf by the home due to the key not being available. In view of this the home will ensure that an audit of monies is now completed and a copy of this is submitted to the Commission for Social Care and Inspection, (CSCI). Also it was unclear how individuals would have obtained any monies they required for that day and therefore the home must review its procedures around the key holding facilities with regards to obtaining individuals monies at all times. At the homes last inspection agency staff were being employed by the home without the necessary recruitment checks in place. Positively this practice has now stopped as we were assured by the support manager that the home no longer employs agency staff. Care Homes for Adults (18-65 years) Page 25 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Beechlawns provides an improved environment that is a well maintained, comfortable and a safe place to live. Further improvements in terms of ensuring that it meets the needs of the people who live there will enhance this home further. Evidence: The home is kept clean, hygienic and tidy and provides a homely and welcoming environment to live in. The AQAA echoes, All staff receive infection control training and measures are in place. The homes refurbishment has improved and housekeeping programmes are in place for staff to follow. However, the staff training matrix does not highlight that all staff have received training in infection control as discussed further in the staffing section. Beechlawns is situated in a residential area and is a large detached house which is spread over two floors and a cellar. There is off road parking located at the front of the home. It is an old style building which has resulted in rooms such as the kitchen having a step down into it and the cellar where the laundry room is located by steps down to it. This physical environment brings a challenge to the people who live at Beechlawns as they maintain their own levels of independence and progress through the ageing process. It was also a concern voiced at the homes last inspection. Care Homes for Adults (18-65 years) Page 26 of 40 Evidence: However, the home does have a stairlift to all first floor bedrooms and a bathroom for individuals who are unable to climb stairs. Also as mentioned in the lifestyle section of this report staff have assured us that all of the people who live at Beechlawns are able to access the kitchen area without any difficulties. The home has installed a grab rail by the kitchen area for people to use. We observed one person in the kitchen area when we visited. There are bedrooms located on the ground and first floor of the home. We were given permission by one individual to look in their bedroom. We found this to be decorated and furnished to a high standard with the individuals own personal items to reflect their tastes and personality. There are no en-suite facilities in any of the bedrooms but there is easy access to toilets. We were told that there are now appropriate locks and door handles to all bathing and toilet facilities. This ensures the dignity and privacy is maintained for all who live at Beechlawns which is an improvement that has been made since the homes last inspection. The kitchen area is bright and clean having been redecorated. At the time of our visit there was a leak coming from the ceiling area which is going to be repaired now that the problem has been located. Off the kitchen area is a built on side room where one of the people living at the home used to spend time as it was close to an outside door where they smoked. However, this person has now died and we were told that this room may become a sensory space to provide stimulation and relaxation to individuals. We did not assess the cellar area where the laundry is completed but we were told that there is no mould or damp odour now as was found at the homes last inspection. Therefore walls must have been redecorated as the home has an ongoing redecoration programme at the present time. There is a pleasant garden to the rear of the premises mostly laid to patio. There are raised flower beds and this year the staff are planning to support and encourage people to grow some seeds for these areas. The garden has suitable perimeter fencing to provide privacy. Care Homes for Adults (18-65 years) Page 27 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is continuing to improve in respect of providing suitably trained staff on duty in sufficient numbers so that peoples needs are met and their wellbeing and safety is maintained. Evidence: There were two staff on duty on the day we visited. The support manager came into the home especially to assist with the homes inspection due to the acting manager not being on duty. We were told that there are two members of staff in the mornings, afternoons and evenings. Through the night there are also two staff on duty but one is awake and the other sleeps but is on hand should assistance be required. We sampled the staffing rotas and found that these confirmed what we were told. The rotas do not show any staffing levels falling below what the home confirmed with us. We observed staff interacting with individuals in an unhurried manner and any tasks were completed which further confirms that staffing levels seem to be appropriate for the four individuals living in the home at this time. We were told that the home have stopped using agency workers and this means that people who live in this home have consistency in the support they receive due to building familiar relationships with staff, some of whom have worked at the home for many years. Care Homes for Adults (18-65 years) Page 28 of 40 Evidence: Staff told us:- We think a lot of them, treat them as a family. Quite a happy home. Two staff records were sampled and we found appropriate recruitment documentation, such as, Criminal Record Bureau (CRB) checks, and completed application forms. In one of the files we only found one reference and the other was missing from the staff members last employer. Records included two written references for each person and a copy of an application form. This demonstrates that the home has carried out appropriate checks to make sure staff employed by them are suitable to work with vulnerable adults. The AQAA confirms that seven members of staff out of eleven indicated to us have achieved their National Vocational Qualification, (NVQ), Level 2 in Care. This exceeds the standard of 50 . The AQAA confirms, Aim to have the whole staff team NVQ 2 trained and encourage staff to go on to higher levels of training and access course specific to the homes service users through colleges and training providers. The matrix also confirms that generally staff have been maintaining their mandatory training in health and safety, moving and handling, food hygiene, safe handling of medications and fire training. However, there are some gaps in training as some staff members have not completed infection control training but this should be rectified as we were shown that some further training in this subject area is planned for the end of January 2009. In addition to this only four staff have completed communication passport training together with only five staff completing person centred planning courses. We found no indication on the training programme that any further courses in these subject areas are planned. We therefore urge the home to obtain some more training dates in communication passport and person centred planning courses as these are important in relation to understanding individuals preferences and areas of concern as discussed previously in the section on individual needs. The home needs to ensure that their staff training matrix is continually updated to reflect the courses that staff have attended as COSHH (Control Of Substances Hazardous to Health) is not indicated on the matrix at all but the training schedule shows that staff attended this course on the 15 January 2009. This will ensure that training and refresher courses are planned appropriately and are not missed due to the homes recording practices. It was positive to find that some staff have received specialist training in order to meet individuals needs, such as, learning disability qualification, diabetes, epilepsy and challenging behaviour. We also found an ongoing training programme which highlighted dates for staff to attend courses in the Mental Capacity Act, nutritional screening and equality and diversity. This shows that the home are now being proactive in providing staff with appropriate training. This goes some way to ensuring Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: that people living at Beechlawns can feel confident that the care and support they receive is provided by a skilled and knowledgeable staff group. Care Homes for Adults (18-65 years) Page 30 of 40 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further work with regards to care planning, risk assessments, staff training, quality assurance and completing regular practice audits is needed to ensure the health and welfare of people is fully met. Evidence: The acting manager was not on duty during this inspection but we were given full assistance by the support manager for the organisation, Teresa Owen, who came to the home especially to assist with the homes inspection. We were told that the acting manager holds a NVQ Level 2 and 4 in care. Staff told us that a new manager who worked at one of the organisations other homes would be commencing at the home on Wednesday 28 January. A random inspection was undertaken on the 31 March 2008 to look at what actions had been taken to address the two requirements that had been made at the homes last key inspection on the 28th January 2008. The outcome of the random inspection was that the home had improved its practices in relation to managing individuals Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: monies and its management of fire safety. Therefore ensuring people who live at Beechlawns are better protected in these two specific areas. However, the home continues to have some areas that require improvements. These have been reflected throughout this report and are highlighted at the end of this report as good practice recommendations. The home should now give some serious consideration to these recommendations to improve the outcomes for people who live at Beechlawns together with ensuring their health and welfare is not placed at risk. Prior to the inspection the acting manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, was taken into consideration. However, we did find that some of the information supplied was not accurate and examples of this can be found throughout this report. Therefore we strongly recommend that the homes AQAA does hold accurate information with examples of practices and procedures. This provides confidence that the home is open and transparent and has the best interests of the people living at Beechlawns at heart. We found that the area manager had recently visited the home to complete an Regulation 26 visit, these report on the quality of service being offered to the people at the home. For example, any complaints or compliments, staffing issues, maintenance issues in the home and so on. These are now completed on a regular basis by the area manager. We found that people and staff members are involved during these visits in order to seek their views about the services provided. Therefore we can be confident that there is a systematic system in place to review and improve outcomes for people living in the home. The reports demonstrate that the service is able to identify and make improvements as necessary. This process now needs to be analysed within the homes quality assurance systems to ensure that this is now developed and expanded to ensure that the home is run in the best interests of the people who live at Beechlawns. We found that a residents meeting had been held on the 6 January 2009 and family members had also attended this. It was positive to note that all people who attended were able to have their say in relation to further outings and interests that could be pursued. For example, some individuals would like to go to, the sealife centre, Stratford and Blackpool. Also people received explanations from the homes staff about the decoration and refurbishment of the home which suggests that peoples views are valued and listened to. However, there is now room for improvement in relation to keyworkers meetings as mentioned earlier in this report in concerns, complaints and protection section. We could not find any documentation that these are being consistently held and staff could not confirm when the last meeting was held. These Care Homes for Adults (18-65 years) Page 32 of 40 Evidence: meetings are important as they provide one to one time for individuals to discuss the support they are receiving together with empowering people to make choices around their daily lives. We found that health and safety checks were completed. For example, staff test the water temperatures weekly to make sure they are not too hot or cold. Records showed that they were within the recommended safe limits so that people were not at risk of being scalded. The water had been tested for Legionnella in the year 2007 but we could not find any certificates of confirmation that the water had been tested after this time. However, the homes provider was contacted who confirmed that the water had been tested and a certificate would now be sent to the home for their records. A Corgi registered engineer completed the annual test of the gas equipment and stated that it was in a satisfactory condition. An electrician completed the five yearly test of the electrical wiring and stated that it was in a satisfactory condition. The fire risk assessment detailed what action needs to be taken to ensure that the risks of there being a fire are minimised as much as possible. We also found fire safety assessment in pictorial format which is positive to see. Fire records showed that staff test the fire equipment regularly to make sure it is working and it was confirmed that a test is due to be completed. An engineer regularly services the fire equipment to ensure it is maintained in good working order. Regular fire drills are held so that staff and the people living there know what to do if there is a fire. These records show that people are protected from any risks to their health or care needs within peoples living environment. We viewed accident records and found one accident which had a description of what happened together with what action had been taken and this looked appropriate. It was signed and dated. However, in the accident book used for staffing accidents we found that in 2007 staff were also recording accidents in relation to individuals living at the home. The support manager has now removed these so that staff are not confused where they should be recording accidents to ensure data protection procedures are followed. We could not find any analysis that takes place in relation to accidents. Therefore it is strongly recommended this takes place and where necessary action taken to reduce risks to people who live in the home and staff alike. The support manager acknowledged the shortfalls that have been documented throughout this report particularly in the areas of care planning and risk assessments. However, the support manager assured us that these would now be put in place so that individuals are not placed at risk and or their care does not meet their needs appropriately. Care Homes for Adults (18-65 years) Page 33 of 40 Care Homes for Adults (18-65 years) Page 34 of 40 Are there any outstanding requirements from the last inspection? Yes R 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 23 13(6) That the practice of residents 29/01/2008 funding their own and care staffs meals when out in the community cease until written confirmation is in place that the funding authority agrees with these practices - Immediate Requirement Form issued during inspection. Action must be taken to reduce the risk of harm to residents in the event of a fire. This must include Complying with the contents of West Midlands Fire Service report dated 22 May 2007; Ceasing the practice of wedging a fire door and; Ensuring all staff participate in a dire drill at least every 6 months. 04/02/2008 2 42 17(2) 23(4) Care Homes for Adults (18-65 years) Page 35 of 40 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 Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement 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 1 The statement of purpose and service user gudie require reviewing to ensure that all information is factually accurate so people who are considering living there are not mislead. The Home should continue to introduce and complete a person centred approach (such as essential life style planning) and reproduce care plans in formats suitable for service users. Further work should be undertaken to ensure routines are flexible to meet residents needs and choices and not solely for the smooth running of the home. That staff receive guidance regarding the contents of communication plans and that these are used as working documents to ensure residents needs are met. That greater efforts are made to support residents to develop life skills. To consider referrals to specialists for support with introducing activities such as O.T.s That an assessment of the premises is undertaken by a qualified person such as an Occupational Therapist to ensure every effort is made by the home to ensure Page 36 of 40 2 6 3 7 4 7 5 6 7 12 14 14 Care Homes for Adults (18-65 years) residents have freedom of movement and can undertake life skills of their choice. 8 14 Work should be undertaken to ensure residents can undertake activities on an individual basis in order that their individual needs and preferences are recognised and met (promoting a person centred approach to care). All activities should be recorded on each individuals daily records so that this can be provded for inspection and can reflect what stimulation has been provided together with the individuals own thoughts and choices for monitoring purposes. That residents be given the opportunity to be involved in food shopping and that this is recorded within individuals activity schedules in care records to enable this to be monitored and provides development of life skill for people who live at Beechlawns. To liaise with the district nurse to determine whether one person requires one and half hourly checks during the nighttime for catheter care so that privacy and dignity are maintained. Care plans and risk assessments must be in pace to reflect the reasons for checking on all individuals through the night time period with clear dates for reviews in place so that peoples privacy is not encroached upon. Weight recording sheets should be completed on a regular basis so that any loses and gains can be quantified appropriately so that any detection of underlying health conditions do not go undetected. To continue to pursue other professionals to assist in the completion of Priority for Health screening tool (and for support staff to complete relevant sections of the booklet where required). The Primary Care Trust should be contacted if the home has difficulty obtaining support from health professional in order that residents living at the home are not disadvantaged. All prescribed creams and lotions should be dated when opened and state which part of the body they should be applied to so that peole are protected by the homes medication administration practices. All prescribed creams and lotions should be kept in lockable facilities so that people are protected from harm. That medication competency assessments be completed on a regular basis for all staff that administer medication to ensure staffs practices comply with good practice. 9 14 10 17 11 19 12 19 13 19 14 19 15 20 16 17 20 20 Care Homes for Adults (18-65 years) Page 37 of 40 18 20 End of life care plans should now be sensitively sought so that individuals can be reassured that when the time comes they will receive the care and support which takes into account peoles preferences. All complaints and concerns need to be formally recorded so that there is a clear audit trail of how the home have acted upon this ensuring that peoples rights and views are listened to. That systems are introduced such as regular key worker meetings and introducing as a set item on the staff meeting agenda concerns to be raised by staff on behalf of residents in order to promote residents rights to complain. The home must review its procedures in relation to accessing individuals monies at all times so that peoples rights are upheld. It is suggested that the manager seeks the advice of the Local Authority commissioners with regard to bedroom furniture which as been paid for by individual residents when the home was run by the former owners. Written records must be maintained of the outcomes from these discussions and any action taken. Staff could not state which furniture and or any evidence to suggest that individuals paid for their own furniture. Therefore not able to fully assess at this inspection. 19 22 20 22 21 23 22 23 23 32 To ensure all staff have undertaken person centred planning training so that individuals can be reassured that their needs are met in the way they prefer and at times suitable to them. Staffing levels should be reviewed in order that individuals can participate in one to one activities. Not fully assessed at this inspection. 24 33 25 35 To review the training matrix in order that it details all training staff have participated in so that refresher courses are not overlooked and happen in a timely manner to ensure staff have the knowledge and skills to meet the needs of people who live at Beechalwns. To continue to ensure that all staff have had an annual appraisal and to ensure this is completed in full. Not fully assessed at this inspection 26 36 27 36 That the frequency of staff meetings increase to ensure staff receive further support in order to carry out their roles. Care Homes for Adults (18-65 years) Page 38 of 40 Not fully assessed at this inspection. 28 36 That all staff receive regular, formal supervision in order to support them to fulfil their roles. Not fully assessed at this inspection 29 39 The registered person must ensure that the information provided in the Annual Quality Assurance Assessment, (AQAA), submitted to the CSCI is accurate and up to date, as this will be verified at inspection visits. To continue to fully implement effective quality assurance and quality monitoring systems based on seeking the views of service users, stakeholders, families and advocates. There should be an annual development plan for the home based on a systematic cycle of planning-action-review. That staff surveys be implemented as further aids to quality monitoring. Further improvements should be made to residents surveys for example with the use of colour and large print. The use of independent advocates to support residents to complete these would also enhance the process further. Accidents recorded appropriately to maintain data protection is followed. 30 39 31 32 33 39 39 39 34 42 Care Homes for Adults (18-65 years) Page 39 of 40 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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