Inspection on 13/11/08 for Old Park Avenue 123

This inspection was carried out on 13th November 2008.

CSCI found this care home to be providing an Excellent 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

Old Park Avenue 123 28/11/06

Old Park Avenue 123 13/02/06

Old Park Avenue 123 15/07/05

Old Park Avenue 123 03/02/05

Old Park Avenue 123 23/06/04

Similar services:

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Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Old Park Avenue 123 123 Old Park Avenue Enfield Middlesex EN2 6PP     The quality rating for this care home is:   three star excellent 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: Margaret Flaws     Date: 1 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect 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 28 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 28 Information about the care home Name of care home: Address: Old Park Avenue 123 123 Old Park Avenue Enfield Middlesex EN2 6PP 02083421636 02083421636 eileen.carr@lineone.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Eileen Carr,Mr Patrick Carr care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Mrs and Mrs Carr offer a service to two residents in their family home. The residents have learning disabilities. The home was first registered in 1997. Mr and Mrs Carr first began caring for people as adult foster carers and then moved into residential care. They decided not to register with the Adult Placement Scheme as originally they would not accept services with more than two service users. Mr and Mrs Carr provide all the care and have back up respite support available. The home is a large semi-detached house located near to Enfield Town. The shops and public transport are near the home. The service is comfortable and homely. Residents go out independently and with support. Fees for the home are between £400 - £600. 3 3 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 28 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: three star excellent 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: This unannounced inspection took place over one day and was undertaken by Regulation Inspector Margaret Flaws as part of the routine schedule of inspections for the home. The last key inspection on this service was completed on 28 November 2006. Mr and Mrs Carr were available throughout the inspection and we talked at length to them. Both residents were also at home and we were able to speak to them and observe how they spent their day. We also toured the building and saw resident and general home records. The home provided us with an excellent quality Annual Quality Assurance Assessment Care Homes for Adults (18-65 years) Page 5 of 28 (AQAA), which along with other information they sent us since the last inspection, formed part of this inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 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 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that their needs would be fully assessed prior to coming to live in the home. Evidence: There have been no new admissions to the home since the last inspection in November 2006. Both of the current residents have lived there for many years. There are clear guidelines in place for referrers and good information about is is offered available for prospective residents. Mrs. Carr said that since the last long term resident died in 2006, the home has received a number of enquiries from the main placing authority (London Borough of Enfield) but is not considering any new long term placements. The Annual Quality Assurance Assessment provided to CSCI stated: in order to meet the needs of others, we are very clear about what we can and cant offer and only accept people whose needs we can meet long term. Mr. and Mrs. Carr also said that Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: they also carefully consider the needs of the people currently living there and what impact another person coming to live in the home might have on them. The home formally reviews the needs of the residents every six months and the London Borough Enfield Reviewing Officer undertook annual reviews for both residents in February 2008. Care Homes for Adults (18-65 years) Page 10 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are fully assessed and their wishes respected and met, to enable them to live independent lives. Any risks to the residents are fully assessed to protect them. Evidence: On the day of the inspection, both residents were at home and we were able to speak to them about their lives and observe how they spent their day. We also spoke at length to Mr. and Mrs. Carr about how the residents individual needs and choices were considered and put into practice and saw the comprehensive files for both residents. The care plans were clear and outlined how the residents chose to lead their lives,with goals formally assessed, discussed and reviewed every six months. The care plans included a good information about each residents interests and needs. Although these needs and wishes are well known to Mr. and Mrs. Carr because the residents have lived in the home for a long time, it was clear from the plans that they worked hard to Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: help the residents improve their lives with new experiences and challenges on an ongoing basis. The daily notes in the care files were of a very high standard, with clear person centred information and accounts of events and actions. In last inspection report, we wrote: These notes are.. of a standard that larger and better resourced homes could model. The quality of the record keeping has continued to improve to an excellant standard. The residents both said that they felt very pleased to live in the home and that their needs and choices were very well considered and supported. They told me that they were able to choose how they spent their time. One resident said she like to get up late and eat as and when she wishes. We observed her doing this. The other resident said he chose to spend much of his day time in the community or watching films or reading. Both residents had formal annual reviews, which they participated in, completed by the London Borough of Enfield in February 2008. The home completes its own formal reviews six monthly. Risk assessment reviews are ongoing and of an excellant standard. For example, one person living in the home has mobility issues and uses a walking frame and a wheelchair. This person is also at a high risk of fractures because of poor bone density. When she changed bedrooms recently (at her request), Mrs. Carr completed a risk assessment for the new bedroom, which included trip hazards and use of a shorter route to the toilet at night. The resident said she felt safe in her new bedroom. Another example of good risk assessment was how the home has supported a resident after a safeguarding incident in the community. This incident resulted in increased risks to that resident and to the home. In cooperation with the resident, Mrs. Carr has developed a new plan for Keeping safe in the Community. The resident said that he is pleased with the support that this plan provides. The home has a good understanding of the Mental Capacity Act (achieved through self directed learning) and states in the AQAA: we could do better to stand back and encourage our service users capacity to make their own decisions even if that decision could be viewed as unwise. They have put this approach into practice, while fully assessing the risks involved, along with resident. Another risk stretching example is supporting a resident to research and plan out a route to Moorfields Eye Hospital for an appointment and going there on the tube. Care Homes for Adults (18-65 years) Page 12 of 28 Care Homes for Adults (18-65 years) Page 13 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to have ongoing opportunities to lead active lives at home and in the community, as they choose. They are supported to maintain relationships and networks that matter to them. Their rights are respected and they are provided with excellent meals. Evidence: The home told us in their Annual Quality Assurance Assessment: Our service users are encourged to achieve goals of personal achievement and independance, enabling them to have access and full involvement in actvities in the community. The two residents have lived in the home for a long time and while many of the patterns of their lives remains similar that at the last inspection, they told us that they are continuing to expand their horizons in the community they are part of. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: One resident spends time at home and accompanying Mr. and Mrs. Carr into the community. She said that she enjoys going out and about in the car around North London. She does not like attending day centre and said that she preferred time spent on individual activities, which allow her more choices. Mrs. Carr said that this resident has also attended their family events on a regular basis and has had a holiday this year in Lanzarote with Mrs. Carr. The other resident had an annual holiday in Brighton. One resident is doing flower arranging sessions at home. She accompanies Mrs. Carr to the local garden centre, where Mrs. Carr is studying flower arranging to support this residents interest. They then do flower arranging sessions together at home. The other resident likes to spend time participating in self directed community activities. These include going to the library, the cinema and visiting the West End theatre district. He has produced his own weekly timetable, which he showed me. He is planning to go to college next year to study either drama or cooking. He also said that he is becoming more comfortable with his gay sexual orientation and is hoping to access support networks in the community. He said that Mr. and Mrs. Carr have been very supportive in helping him realise that he is not alone, for example, by having discussions about gay characters in soap operas on television and by helping him learn about new opportunites that are available to him. The home has done a marvellous job of recognising and supporting the equality needs of this resident in a way that has made a real difference to his perspective on life. This resident also wrote a letter to the Enfield Council Reviewing Officer outlining his interests and making clear how he understood his rights. Both residents have relationships with members of their families, who visit and whom they visit. The food in the home is home cooked food made according to each residents choice. There are no set meal times because the residents like to eat at different times. Mr. and Mrs. Carr said that this is easily managed in the home setting. The food we saw was good homely and nuritrious. One resident has to be careful with the amount of fat he eats and the home has provided him with information on diet. Menus and records of what people ate are recorded simply. The kitchen is an ordinary home kitchen, with good stocks of food. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home makes sure that the residents physical and emotional needs are met, to support their wellbeing and quality of life. Evidence: We checked the care plans and health files for both people living in the home. We also spoke to both residents about their health needs. The standard of documentation was very good. The one resident who receives personal care support was happy with care provided in a respectful way. There was excellant evidence of how both residents emotional wellbeing was supported on a daily basis and both residents confirmed this. One resident has mobility difficulties and uses a walking frame in the home and a new wheelchair when she goes out. She said she felt safe with these aids. Mrs. Carr showed us the new wheelchair which is lightweight and easy to handle. Risk assessments cover the use of this equipment. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: We saw evidence and it was clear from our discussions with Mr. and Mrs. Carr that they take a very proactive approach to the residents health needs. They act as advocates for the residents with healthcare professionals to make sure that the residents get good medical reviews and care as and when needed. One example well documented in the records was the support provided for a resident with asthma and a recurrance of epilepsy. The home has provided excellant support to one resident who needed medical checks following a safeguarding concern. We saw a letter from a healthcare professional who said that he was very impressed with the way in which Mr and Mrs Carr supported this resident. Regular dentist , doctor, hospital, optician and other healthcare appointments are in place and one resident is currently having follow-up checks for an eye condition. One resident now self medicates. He showed me the system he uses and said that it works very well for him. He keeps his medication in a locked container and has his own plain language copy of the procedure, which he said he keeps with him. He also said that he tells Mrs. Carr when his medication is due to run out. The home has completed a medication risk assessment for this resident. We saw the homes medication system and discussed this with Mrs. Carr. She said that the home is now using Boots Chemist to provide the medication and work with home. Mr. and Mrs Carr are booked for further training in medication. The medication records and system we saw were straightforward,accurate and appropriate to the home. Care Homes for Adults (18-65 years) Page 17 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home know how to complaint and are protective by sound complaints policies and procedures. People living in the home are safeguarded by the homes policies and policies and by the excellent proactive stance the home takes to make sure that they are kept safe. Evidence: The complaints policy and procedure is sound and available to the residents in a form that they can understand. We saw the complaints records and none have been recorded since the last inspection. Both residents we spoke to said that they were comfortable talking to Mr. and Mrs. Carr if they had any concerns. The home has a copy of the London Borough of Enfields Safeguarding Policy and Procedure. Since the last inspection, two safeguarding referrals have been made by the home to Enfield Council. One referral, concerning a residents access to their own money was resolved by the local authority becoming the Financial Appointee for this resident. The other, concerning the safety of a resident in the community, has had a good outcome. In both cases, the home demonstrated excellant practice in safeguarding and Mr. and Mrs. Carr have worked very hard to protect the residents from potential harm. Care Homes for Adults (18-65 years) Page 18 of 28 Care Homes for Adults (18-65 years) Page 19 of 28 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. Residents live in a homely, comfortable environment that is maintained to a good standard and kept clean and safe. Evidence: The home is a comfortable domestic residence. It is spacious and well maintained, with two large lounges and a homely kitchen. The residents have their own attractive rooms, overlooking a large garden that they use in the summer. The lounges are furnished with televisions, DVD player and music system. One resident also has an extensive film and book collection, for which Mr. Carr has built new shelves. The home is regularly redecorated. One resident has chosen to move into another room recently and she said she likes this room very much. Mrs Carr said that it is a better room for this residents mobility difficulties. She also said that this resident has been learning to use the laptop computer and enjoying it, so they may purchase one for her use. The laundry facilities are in the garage and the home has a good infection control policy and procedure. Care Homes for Adults (18-65 years) Page 20 of 28 Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately staffed to meet the residents needs. Evidence: Mr. and Mrs. Carr run the home by themselves and do not use relief staff. The staffing level that they provide is suitable for the residents needs. They have explored options for respite for one resident, to cover periods when they take a holiday (the other resident goes to family). The resident has had one respite stay in a large, comfortable home on the outskirts of London. This was successful and the resident said that she like it. This resident also regularly accompanies Mr and Mrs. Carr on trips, for example, to Ireland or elsewhere in Europe. We discussed training and learning development. The home is proactive in learning what is needed to meeting the residents needs. For example, they are able to access self directed learning on the internet or through journals and books about current best practice. One example of good practice was the learning that Mr and Mrs Carr did on the Mental Capacity Act. They became sufficiently knowledgeable on the Act to advise other professionals on it. They are trained in fire safety, food hygiene, safeguarding adults, They were due to have a medication training update with Boots Chemist. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: In some areas of core training, they have done courses in the past that need updating. Although Mr and Mrs Carr have had their manual handing practice assessed by a physiotherapist who watched their practice with one resident who requires support, a recommendation is made that they do refresher training in manual handling to make sure that they keep up to date with good practice. A similar recommendation is made for first aid training. Mrs. Carr has her Registered Managers Award. Care Homes for Adults (18-65 years) Page 23 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This well run home protects the residents, listens and responds to their wishes and safeguards their interests. Evidence: While the management of the home is well matched to the its scale, in ways demonstrated throughout this report, Mrs. Carrs management and the approach taken along with that of Mr Carr, exceeds the standard of management found in better resourced and larger homes. Challenges are managed proactively in the residents interests. The approach taken to safeguarding, for example, has generated excellant outcomes for both residents, because of Mrs Carrs open but determined style. Another example was the production of a very good Annual Quality Assurance Assessment, despite having received poor quality advice from a paid consultant. The home consults appropriately and professionally with other agencies, including CSCI and keeps us informed of significant issues or changes. Residents are consulted on a daily basis with a view to genuine involvement in Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: decisions that affect them. They complete a simple annual survey which is held on file. The home has excellant record keeping and has good systems for supporting the residents with their finances. The safeguarding matter referred under the outcome area for Concerns, Complaints and Protection concerned one residents finances and these are now under the appointeeship oversight of the local authority. We saw the records produced for the review and they were comprehensive and clear. The home has up to date health and safety certificates in place. Fire safety is taken seriously and residents are involved. For example, Mrs Carr said that the residents enjoy the six weekly fire drills and have their own copy of the fire evaucation procedure. There is good quality, regularly serviced fire equipment in the home and a fire risk assessment. Mr Carr tests the fire and smoke alarms weekly. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 26 of 28 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 35 That the home updates training in manual handling and first aid. Care Homes for Adults (18-65 years) Page 27 of 28 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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