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Inspection on 07/07/08 for Crystal Residential Home

Also see our care home review for Crystal Residential Home for more information

This inspection was carried out on 7th July 2008.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The atmosphere at the home was calm and relaxed, people we spoke to said that they were comfortable and liked living at the home. The manager has a positive attitude and appreciates what needs to be done to continue improving the quality of care offered at the home. The garden is attractive and well cared for, an attractive place to sit and enjoy alfresco eating. Required health and safety checks have been carried out, we checked the records, which were up to date and complete.

What has improved since the last inspection?

Since the last inspection there has been a lot of redecoration and improvement in the house. A wall has been knocked down between the lounge and the room behind, which has increased the size of the lounge and gives access to the garden.Two of the toilets have been decorated and retiled and the communal areas have also been decorated, including the dinning room that has also had the flooring replaced. Polices and procedures have been reviewed during the last year and new assessments and care plans have been implemented. A lot more information is being collected during the assessment process, so care plans are more detailed. The manager has acknowledged that the care plans could be further improved by the addition of a little more detail. Health and safety in general has improved, there were no gaps in the required safety checks or the records. Meals are freshly prepared, the meal that was served while we were at the home looked appetising and was served in ample portions. There was a choice to two meals and when someone asked for a fried egg to be added to their sausage and mash it was quickly prepared for them.

CARE HOMES FOR OLDER PEOPLE Crystal Residential Home 97 Woodcote Grove Road Coulsdon Surrey CR5 2AN Lead Inspector Ann Wiseman Key Unannounced Inspection 09:30 7th July 2008 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 Crystal Residential Home DS0000025777.V365062.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. Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crystal Residential Home Address 97 Woodcote Grove Road Coulsdon Surrey CR5 2AN 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) 020 8660 8643 F/P 020 8660 8643 jaisreenemchand@yahoo.co.uk Mrs Jaisree Nemchand Mrs Jaisree Nemchand Care Home 12 Category(ies) of Dementia (12) registration, with number of places Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 12 12th September 2007 Date of last inspection Brief Description of the Service: Crystal Residential Home is registered to care for up to twelve older people. It is owned and managed by the same person. The house is a large detached residence set in the attractive suburb of Coulsdon. The home provides accommodation arranged over two floors; there are eight single bedrooms and two double rooms, which are presently occupied by married couples. All bedrooms have a wash hand basin, while one is ensuite. There is a passenger lift allowing easy access to both floors. The home has a large garden to the rear of the building and off road parking to the front. The parking area has been resurfaced, and a new wheelchair ramp installed to the front of the house. The home provides information about its services in a User Guide, which is made available to people living in the home and anyone considering moving in. Additional information can be found in the home’s Statement of Purpose. The current weekly fees (as provided at the time of this inspection) range from £373.60 - £430. Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection and we arrived at the house at 10.30am and the manager made herself available to facilitate the inspection and was open and friendly throughout the visit. We were on site for six hours. During the day we met and chatted to several people as we were shown around the building. The house was clean and tidy and the atmosphere was friendly and congenial, interaction between the staff and the people living in the home was friendly and staff responded to them in a supportive and respectful manner. The manager has sent us the Annual Quality Assurance Assessment (AQAA) she had completed. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. As well as speaking to people we looked at three of their care plans. We also spoke with two staff members and inspected three staff personnel files and sampled health and safety records, which were up to date and in order. Overall the home was found to be comfortable and able to meet the needs of those people living there. What the service does well: What has improved since the last inspection? Since the last inspection there has been a lot of redecoration and improvement in the house. A wall has been knocked down between the lounge and the room behind, which has increased the size of the lounge and gives access to the garden. Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 6 Two of the toilets have been decorated and retiled and the communal areas have also been decorated, including the dinning room that has also had the flooring replaced. Polices and procedures have been reviewed during the last year and new assessments and care plans have been implemented. A lot more information is being collected during the assessment process, so care plans are more detailed. The manager has acknowledged that the care plans could be further improved by the addition of a little more detail. Health and safety in general has improved, there were no gaps in the required safety checks or the records. Meals are freshly prepared, the meal that was served while we were at the home looked appetising and was served in ample portions. There was a choice to two meals and when someone asked for a fried egg to be added to their sausage and mash it was quickly prepared for them. 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. The summary of this inspection report can be made available in other formats on request. Crystal Residential Home DS0000025777.V365062.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 Crystal Residential Home DS0000025777.V365062.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 5 and 6 were examined on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People considering moving into Crystal Residential Home are given enough information to enable them to make an informed choice about the home and have an opportunity to visit and assess the suitability of the service. People’s needs are assessed before anyone moves in. This service does not offer Intermediate care. EVIDENCE: We examined the home’s Statement of Purpose and User Guide; it covered all the areas required by the Care Homes Regulations but has not been updated since 2005 and needs to be reviewed to reflect recent changes in legislation. Also, the owner has recently been granted a variation to her registration to allow them to offer places to more people who have dementia. Potentially she Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 9 could have 12 people living in the home with dementia as their primary diagnosis. People thinking of placing their relative with a cognitive impairment in this home will be reassured that they will be properly cared for, if the statement of purpose and user guide explains what expertise the staff have to offer this form of support and how it will be applied. During the inspection we examined three peoples files and found that they contained assessments that had been done before people moved into the home, they were detailed and contained personal histories. The layout of the assessments has been improved since the last inspection and they now ask for more details. The manager has expressed a desire to add more details to the histories now that she has completed the changeover to the new style assessments and care plans. People are given an opportunity to look around before they decide if they want to move in and are invited to have a meal at the home. Crystal Residential Home DS0000025777.V365062.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 were inspected during this visit. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in this home benefit from having care plans in place and having their health needs fully met. Medication is managed appropriately, people are treated with respect and their privacy is upheld. EVIDENCE: The home has restyled all of the care plans and we examined three peoples files. The AQAA says that, “The philosophy of the home on care is based on how well the people living here are treated and that their dignity is preserved at all times…………We ensure that people feel safe and that their wellbeing is cared for.” The new styled plan we saw was well presented and contained enough information for carers to be able to offer support in a way that the people Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 11 prefer and had been reviewed monthly. People we spoke to agreed that they were asked to supply information for inclusion in the plan. Files evidenced that people received the health care they need. Records of doctor’s visits and hospital appointment letters were on file. People also have access to dentists, opticians and chiropodist as well as specialist care such as psychiatry and speech and language. All appointments and their outcomes are recorded on the care plan. We carried out a check on the medication and it’s records and no errors were found. The manager assisted us with the check and displayed a good knowledge of the medication. The manager assures us in the AQAA that all staff treat people with respect and uphold their privicy. Staff personnel files held evidence that staff receive training in this area and observation of interactions between people and staff members was seen to be respectful, discreate and supportive. People’s wishes on end of life care is recorded where people want to discuss it. Crystal Residential Home DS0000025777.V365062.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 12, 13, 14 and 15 were assessed during this inspection. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. This home offers a daily routine that is varied and flexible, people’s interests are recorded and they are given opportunities for stimulation through leisure and recreation. Visitors are made welcome at the home and people can receive visitors in private and are supported to exercise choice and control over their lives. Menus are varied and food portions are ample. EVIDENCE: When assessments are being done people and their relatives are asked to talk about what they like to do and how they can be helped to continue with their favourite activities. They are also asked what food they like and other lifestyle preferences. We examined three care plans and found that the details collected during the assessments were then put into them, making it possible for staff to offer support in a way that would be liked by the people receiving it. When we spoke to them, people said that they had been asked to take part in this process. Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 13 The manager told us that this is one of the areas she wants to concentrate on improving as she develops her new style care plan. She believes that the more staff know about the people they care for, the more person centred the service they get will be. The AQAA says that, “We ensure that the routines of daily living and activities made available are flexible and varied to suit each person’s expectation, capabilities and performance…” we found evidence that entertainers are invited in to perform for the people in the home and they hold parties for special occasions and plan to find ways to encourage more relatives to attend the gatherings. There are photos of a recent outing to a local pub for lunch displayed on the wall and there is a selection of table activities in a cupboard in the lounge. One staff member told us how she would sometimes help people to do jigsaw puzzles or to read the newspaper. Religious services are held in the home monthly. The manager normally prepares the main meal and she showed us that she knew peoples individual needs by listing those people who are diabetic and those people who have personal preferences and dislikes. We watched the meal being served; there was a choice of two meals, sausage and mash or a chicken stew. The vegetables were fresh and the food was cooked from scratch, not ready made. The portions were tailored to each person and seconds were offered. People ate well and looked as if they were enjoying the meal, people who needed help to eat was given it from staff who sat with them at the table and interacted in a positive way. One person asked for a fried egg to go with their sausages and it was freshly cooked for them. The dinning room has been decorated recently and new flooring has been laid, the overall effect has been to lighten the whole room. Dining tables were covered with clean tablecloths and condiments were put out for people to use if they wanted them. Drinks were also available. People were not stigmatised by the use of bibs but were given clean napkins to protect their clothes. The whole meal was a leisurely and relaxed affair with people chatting to each other and the staff. Crystal Residential Home DS0000025777.V365062.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 16, 17 and 18 were judged during this visit. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People can be confident that their complaints will be listened to and acted upon. Legal rights are protected and those without capacity are facilitated to access available advocacy services. The homes policy, procedures and practice are aimed at protecting people from abuse. EVIDENCE: Complaints and their outcomes are recorded in the homes complaints book and there is a policy in place. We examined the complaints book and records kept were as required. There haven’t been any complaints regarding this home raised directly with us. One of the care plans we looked at showed evidence that the person wasn’t able to manage their affairs so a relative had taken steps to hold power of attorney on their behalf. The manager assured us that if someone did not have anyone to act for them she would make arrangements for an advocate to support them. This home offers care to people with dementia so it is important that they work within the new Mental Capacity Act 2005 and that the manager and staff have a good understanding of it. We recommend that training on the act be provided for all the staff. Staff have already undertaken safeguarding training. Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 23, 25 and 26 were assessed during this inspection. People who use the service receive Adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in the home have access to comfortable indoor and outdoor communal facilities. The house is clean but is in need of some redecoration, repair and general maintenance. EVIDENCE: The owner has already improved the environment greatly since the last inspection and intends refurbishing the whole building and is in the process of working from room to room decorating and upgrading furniture and soft furnishings. The lounge has been decorated and extended and new easy chairs have been provided. Two bathrooms have been decorated and new carpets have been fitted in some of the rooms. The toilets in the home have been distinguished from other rooms by having the door surrounds painted in a distinctly different colour, this is considered Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 16 good practice in homes that care for people with dementia and talking about it led to a wider discussion about the special needs of these people. The home is decorated with ornate carpets and wallpaper throughout, which many people with dementia find confusing and disorientating. The guide, Alzheimers Society guide to the dementia care environment, provides instrumental guidance and advice on how care home providers can improve the quality of life and care for people with dementia by following simple design rules and principles, we recommend the manager obtains a copy and follow its advice as she redecorates and upgrades the home. The lounge now overlooks the attractive garden. The fishpond has been out of action and drained since a heron stole all the fish and the manager now plans to turn it into a raised garden so people can tend the flowers if they want without having to bend. The bedrooms were individual to each person and there were personal possessions, pictures and ornaments in the rooms but in some of the them the wallpaper is in need of replacement and the furniture is outdated and mismatched. The manager is working on this concern but there is still some improvement needed. She has already replaced flooring in some of the bedrooms so that they are better able to keep the home sweet smelling. Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 27, 28, 29 and 30 were inspected on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in the home have their needs met by sufficient numbers of staff on duty that are competent and qualified. The homes recruitment policy meets requirement and staff receive training. EVIDENCE: We looked at three personnel files and spoke to two staff members. The files contents and the people we spoke with confirmed that the required recruitment procedure is carried out and that safeguarding checks are completed before people start work in the home. Supervision and training records were on file. While we were at the house there was sufficient staff on duty to meet the needs of the people. We were able to see that the staff are capable and those we spoke to displayed a good knowledge of how to care for older people. The Manager has said that she is investigating opportunities for the staff to take training in specialist areas such as dementia care. If English not a staff members first language it could be difficult for them to communicate with people. The manager says that she is aware that this may be a problem and asks foreign workers to always check that people understand what they say and work on improving their English. The manager closely supervises them and makes sure they can identify people’s basic needs during their induction. Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 31, 33, 35 and 38 have been examined on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People benefit from a home that is well managed by a person who is qualified, experienced and fit to be in charge. She puts peoples need to the fore and runs the home in their best interests. EVIDENCE: The manager has shown that she is organised and committed by achieving many improvements in the home over the last couple of years. During our discussions she has shown herself to have a good understanding of older peoples needs and she has realistic and practical plans to improve the standard of care for the people living in this home. Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 19 The AQAA says, “An annual development plan for the home is based on a systematic cycle of planning, action and review. Feedback is actively sought from people through means such as completing questionnaires and having individual and group meetings.” We looked at the file that contains the quality assurance questionnaires that have been returned in the previous years. The manager told us that she reads the replies and responds individually to any concerns raised and takes action to rectify them. The home does not manage any of the peoples monies, they encourage relatives to take control if people can’t manage it themselves and will arrange independent support if they do not have anyone to help them. The home keeps a small amount of spending money for day-to-day expenses and will keep records of money spent and receipts. If someone needs something and does not have any money it will be provided and the relatives will be invoiced. Health and safety is properly addressed. We checked a small sample of the health and safety records and found that they were up to date and properly recorded. Control of substances hazardous to health (COSHH) assessments are in place but are old and need to be redone. Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 X X 2 X 2 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 Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 21 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. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose is due an update and review, during the review it is recommended that the home includes how they intend to support people who have dementia and how they will make sure they will be able to meet their needs. This home offers care to people with dementia so it is important that they work within the new Mental Capacity Act 2005 and that the manager and staff have a good understanding of it. We recommend that training on the act be provided for all the staff. It is recommended that the home obtains the guide, Alzheimers Society guide to the dementia care environment, to enable then to optimise the enviromnt in the home for those people who have dementia. An ongoing programme of redecoration and refurbishment should be developed and continually maintained. COSHH assessments are old and need to be redone. 2 OP30 3 OP22 4 5 OP19 OP38 Crystal Residential Home DS0000025777.V365062.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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