Inspection on 14/09/06 for Chalfont

This inspection was carried out on 14th September 2006.

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

Chalfont 07/10/08

Chalfont 08/10/07

Chalfont 30/12/05

Chalfont 11/07/05

Chalfont 06/01/05

Chalfont 02/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Chalfont 6 Southern Road Southbourne Bournemouth Dorset BH6 3SR Lead Inspector Jo Palmer Unannounced Inspection 10:30 14 September 2006 th X10015.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 Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chalfont Address 6 Southern Road Southbourne Bournemouth Dorset BH6 3SR 01202 420957 SAME AS TEL: 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) Mr Michael Robert Adams Mr Terence Charles Aston Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user (as known to CSCI) under the age of 65 may be accommodated. 30th December 2005 Date of last inspection Brief Description of the Service: Chalfont is a detached property situated in a quiet residential area of Southbourne. It is situated between the seafront and a shopping centre and other local amenities that include a post office, cafes, restaurants, a library and places of worship. Public transport is available within easy walking distance and provides access to other areas of Bournemouth. The home is registered to provide care to up to 10 older people. The accommodation is arranged on two floors and there are 9 bedrooms, 8 are single and there is 1 double. There is a chair lift to assist with access to the first floor. There is a separate lounge and dining room. There is an enclosed garden to the rear of the property with seating. The front of the home has a forecourt, which is used for parking up to 3 cars. There are pets in the home belonging to residents and the registered providers. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection on 14th September 2006 lasted for three hours. Mr Aston and Mr Adams, Registered providers and owners of the home were present throughout and assisted with the inspection. The inspector spoke with three residents, examined relevant records and took a tour of the premises. This was a ‘key’ inspection where the home’s performance against the key National Minimum Standards was assessed. A pre-inspection questionnaire was sent to the manager in order that certain information could be provided, questionnaires were also sent to the home prior to the inspection to be distributed to residents, relatives and visiting health care professionals. The pre-inspection questionnaire had not been returned to inform the inspection. At the time of writing the report, four questionnaires had been received all of which contained positive responses to questions posed. What the service does well: Mr Aston and Mr Adams ensure that any resident admitted to the home has sufficient information following on from assessment so they can be assured the home is the right place to move to where their needs can be met. Basic care plans are written in order that instruction is available for reference detailing how resident’s needs can be met. Care plans address the person’s health and personal care needs, their social and emotional needs and any specific instruction regarding their general well being. Medication is generally well managed although some anomalies were noted that the providers said they would address. Residents have confirmed that they are treated respectfully and this was also evident through observation of the relationships between Mr Aston and Mr Adams who were on duty at the time of the visit, and residents. Residents are happy with the level of activity in the home, which meets their expectation, residents are able to receive visitors at any time and maintain links with the local community as far as their health and welfare allows. Meals are provided in a pleasant dining area and residents confirmed that the food is appetising and plentiful. No complaints have been received by the home but procedures are in place to effectively manage any concerns that may be raised. The premises are homely and comfortable, communal space is available where residents can come together to socialise and private bedrooms meet the needs of the residents. Residents are able to bring in items of their own to Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 6 personalise their room. There are sufficient bathing and toilet facilities around the home. Although staff recruitment has been difficult, it was evident that there are always sufficient numbers of staff, including Mr Aston and Mr Adams on duty to meet the residents needs. Staff training has been minimal although staff employed have attended course appropriate to ensure the health and safety of residents and good working practices. Mr Aston and Mr Adams have been running and managing Chalfont well for many years. Discussion with residents indicated that they were satisfied with the management arrangements and that both registered persons are always available when needed. Residents perceive the care and services provided to be of good quality and to meet their expectations, although attention is needed to ensure that this is now measurable in line with a change in the regulations. What has improved since the last inspection? 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. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good; this judgement is made using available evidence. The admissions process is such that it ensures resident’s needs are assessed prior to admission to ensure the home is able to meet their needs and provide the services they require Standard 6 is not applicable, as Chalfont does not provide intermediate care services. EVIDENCE: Three resident’s care files were examined, one of which was for a person who recently moved to the home, other residents have lived at the home for some time. Mr Aston confirmed that the procedure for accepting a person into the home is such that the resident will be visited prior to admission in order that their needs can be assessed, the file relating to the most recent admission however did not have such an assessment undertaken by the home as the person had come to Chalfont from out of the county and they relied on the assessment and care planning documentation provided by the placing care Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 9 manager. This record provided documented evidence of the person’s needs in order that Mr Aston and Mr Adams could be sure that Chalfont was a suitable environment for the resident where their needs could be met. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good; this judgement is made using available evidence. Care plans provide basic information for staff to inform them of resident’s health and welfare needs and how to meet them although would benefit from further consideration to providing more detailed instruction to ensure the best interests of residents are safeguarded. Most medicines were being given as prescribed and recorded appropriately although attention is needed to ensure all records are accurately maintained to enable effective audit of medication usage in the interests of residents. Resident’s rights to privacy are supported through care delivery, relationships with staff and confidential record keeping practices. EVIDENCE: Care plans provide very basic instruction for staff, which in a larger home with more staff or where service users have more complex needs, would not be acceptable. However, given the consistency of staff in the home who, it was confirmed, have good working relationships and knowledge of resident’s needs, Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 11 care records provide sufficient detail including assessment of risks (if any) and refer to the resident’s rights to respect for their privacy and choice. Records of care provided detail the resident’s life in the home including any personal care provided, any necessary medical intervention by community based health care professionals, the level of social interaction including visits from friends and family and any changes in the resident’s mood, mental or emotional state. Medication is managed using a monitored dosage system where the supplying pharmacist provides resident’s medicines in pre-prepared packs; staff at the home then administer the medicines from the correct day and time slot in the pack to the resident. A record is held relating to medication received into the home in the packs and that, which is given to residents at the prescribed time. The system works well although caution is needed to ensure that where the pharmacy supplies medicines in marked containers, other than the dispensing packs (bottles and boxes), these are given to the resident from the original marked container. Additionally, where a resident moves to the home for a short period of respite care and medicines are bought in with him/her, the registered persons must ensure they know what the medicines are and their purpose and any relevant side effects before administering them. Of the eight residents accommodated, two were sleeping in the lounge and two were sleeping in bed, one was visited briefly in her room but was unable to communicate. Three residents were spoken with although one was unable to engage in meaningful dialogue. Two residents spoken with confirmed they are treated respectfully by a caring staff group who are able to meet their needs in the manner to which they expect. They confirmed that their privacy is respected in their rooms and when receiving assistance with personal care routines. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good, this judgement is made using available evidence including a visit to this service. Social and leisure choices for residents are limited although those spoken with were content with the social milieu. Residents are supported in maintaining contact with their friends and family and in making decisions about their lives in the home. Residents are provided with a varied menu and choices of meals that meet their dietary needs. EVIDENCE: A written schedule of activities, or ‘activities programme’ was not examined although it was evident from discussion with some residents and observation of others that they were generally satisfied with the level of activity in the home. Those spoken with were happy with the arrangements and were able to enjoy books, magazines and newspapers and visits from friends and family, one resident has a pet dog, Chalfont also has two cats and a dog that residents appreciate. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 13 Care records examined detailed the extent to which resident’s individual social and leisure preferences have been taken into account, family involvement was also evident from care documentation with visits being recorded. Residents confirmed they are able to receive visitors freely. Although menu’s were not examined, discussion with residents confirmed that a variety of appetising meals are provided, Residents spoken with confirmed that the food was usually good, the registered providers confirmed that a range of fresh meals are prepared and they cater for special diets as required, currently those being a vegetarian and diabetic diet. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good, this judgement is made using available evidence including a visit to this service. Any person wishing to complain is directed through a written procedure detailing how their concerns will be addressed, they should therefore be confident that their complaints will be listened to and taken seriously. Procedures for responding to suspicions of abuse are held in accordance with Department of Health guidance, meaning that any allegations of abuse can be managed effectively although some revisions to the policy are required. EVIDENCE: The home’s complaints procedure is available to each resident in their room. This guides people through the process of making a complaint and how they can expect to be responded to, residents are directed to the Commission if they are not happy with any intervention by the home. Mr Aston confirmed that no complaints had been received, the Commission also has received no complaints. A copy of the local authority guidelines, ‘No Secrets’ for reporting any issues of abuse are available for staff reference, Mr Aston confirmed that staff have received training in matters relating to adult protection. An internal policy is also available with procedural guidance for staff, this is new to the home and part of a package of policies and procedures that have been bought. A review of this policy evidenced that it covered the main points although did not make reference to ‘No Secrets’ or to the home’s whistle-blowing and disciplinary Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 15 procedures and directed that should any incident be suspected, it must be investigated. This policy did not identify who would undertake the investigation and did not make it clear teat a referral to the adult protection team must be made. No incidents have been reported. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23, 24 & 26 Quality in this outcome area is good. This judgement is made using available evidence including a visit to this service. Accommodation at Chalfont is safe and well maintained. Residents are able to benefit from comfortable, well furnished, clean and hygienic surroundings with some of their own belongings around them. EVIDENCE: There was evidence of regular servicing of equipment including fire equipment and stair lift, the emergency call system is a self testing unit that flags up any problems on the indicator board in order that these can be repaired. There are sufficient bathing and toilet facilities sited around the home, which are provided with appropriate aids and adaptations to meet resident’s needs. Resident’s rooms are comfortable and furnished appropriately and residents are able to benefit from having some of their own belongings around them. The lounge provides a sociable meeting place for residents and a dining room is available where most residents can enjoy their meals. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 17 All areas of the home visited were clean and well maintained and free from offensive odours. The laundry room was not inspected although it was evident from observations of residents dress and bedding that the laundry service is effective. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement is made using available evidence including a visit to this service. The providers ensure through hard work and diligence that there are sufficient staff on duty in the home each day and night to provide the level of care and support needed by residents although only minimum numbers of staff are employed. Staff training programmes are limited although those staff employed have attained the standard level of training required to meet statutory requirements in the best interests of residents. Staff recruitment has been a problem for Chalfont in terms of numbers of applicants although when staff are recruited, they are done so safely ensuring the continued protection of residents. EVIDENCE: Mr Aston and Mr Adams employ just two staff to work in the home. The registered providers live on the premises and are continually available and provide most of the care and support required by residents. Mr Aston stated that although he has endeavoured to recruit more staff, he has had very few applicants, this he puts down to the increasing need for staff to apply themselves to the expected training programmes. However, it was evident that there are two people on duty in the home at all times during the day, at night there is one member of staff with a second sleeping in/on call. The night staff Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 19 are invariably Mr Aston and Mr Adams. Training certificates were seen for one senior carer employed who has achieved the statutory level of training required in mandatory health and safety related subjects. Residents spoke very highly of this member of staff. None of the current staff have attained NVQ training in care, the National Minimum Standards suggest that 50 of care staff employed attain competencies to NVQ level 2. Discussion with Mr Aston during this inspection highlighted the difficulties in recruiting staff due to the demands of this expected training. There are no training programmes for staff in accordance with National Training Organisation workforce training targets; a package of training information provided by ‘Skills for Care’ was sent to the home following the inspection for the registered providers attention. The NTO standards for care staff form a 12-week induction programme that staff should work through to ensure they have the knowledge and competencies to undertake their roles. In the absence of such a training programme, the registered providers have devised an induction programme for staff which concentrates on introduction to the home’s policies and procedures, to the resident’s and their daily care routines and on health and safety matters including fire safety and emergency systems in the home. It remains a recommendation however that new staff undertake induction training to NTO specification. Mr Aston discussed the difficulties experienced in recruiting staff to work at the home. One member of staff has been recently recruited however using appropriate vetting procedures to ensure his suitability to work with vulnerable people. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement is made using available evidence including a visit to this service. Chalfont is managed effectively and in the best interests of residents. Quality assurance programmes and controlled measurement of care and services provided are not in place although the registered providers rely on positive verbal feedback from residents, visitors and the Commission’s inspection findings to inform their practice and develop services. Residents are safeguarded by good procedures for managing their personal financial affairs with support of their families. The health and safety of residents is protected by procedures ensuring that equipment is checked and maintained. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 21 EVIDENCE: Mr Aston and Mr Adams are registered with the Commission to manage the home on a daily basis, both providers have owned, lived and worked at the home for approximately 28 years gaining much experience although neither have attained a management qualification. A policy statement concerning quality assurance is available for reference although no measures have been taken to ensure that regular audits of the service provided take place. Mr Aston confirmed that day to day feedback from residents and their visitors informs their quality assurance process. On 1st April 2006 a change in the regulation introduces a legal requirement for registered providers to produce an Annual Quality Assurance Assessment (AQAA), this will be introduced to care homes in autumn 2006. It would therefore be considered good practice for the registered persons to consider in a development plan, how well in their estimation, they deliver good outcomes for residents at Chalfont including where improvements can be made and what action will be taken to respond to any requirements and recommendations of inspection. Mr Aston confirmed that the home does not assist any of the residents with the management of their finances; residents either manage their funds personally or have the support of their families or representatives. Examination of records of testing and maintenance of fire fighting equipment and emergency lighting demonstrated that these are being undertaken at the required intervals. Checks of the alarm system, emergency lighting fire doors and exits, smoke detectors etc are carried out at the required frequency. A service contract is in place demonstrating the required level of maintenance of the fire warning system, emergency lighting and fire fighting equipment. The registered providers are reminded that a change to the Fire Safety Regulations come into force on 1st October 2006 and to comply, care homes must: • • • Appoint a responsible person Have a fire risk assessment Train staff and • • • Have a system for effective monitoring The keeping of staff training records A systematic review of each fire risk assessment on a regular basis Records of staff fire safety/awareness training show that all staff have received training in the last six months. Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations Where residents come to the home for a short period of respite, it is recommended that the registered persons ensure they have full written documentation regarding the resident’s medication. It is recommended that the home’s internal policy on adult protection and abuse is revised to ensure it refers staff to the local authority guidelines and the home’s whistleblowing procedure, and that the disciplinary procedures are referenced with regard to suspension of staff pending any investigation. It is recommended that the registered persons put in place a statement of intent to indicate the measures they will take to ensure the quality of services is improved or good standards maintained. 1 2 OP18 3 OP33 Chalfont DS0000003925.V311996.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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