Inspection on 15/06/06 for St Marys Care Home

This inspection was carried out on 15th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Marys Care Home 10/02/09

St Marys Care Home 18/09/08

St Marys Care Home 19/06/08

St Marys Care Home 30/10/07

St Marys Care Home 20/02/07

St Marys Care Home 24/01/06

St Marys Care Home 14/11/05

St Marys Care Home 09/02/05

St Marys Care Home 21/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Mary`s Care Home The Old Vicarage Main Street Blidworth Nottinghamshire NG21 0HQ Lead Inspector Karmon Hawley Unannounced Inspection 15th June 2006 10:00 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 St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 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. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Mary`s Care Home Address The Old Vicarage Main Street Blidworth Nottinghamshire NG21 0HQ 01623 795231 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) Broadoak Group of Care Homes Vacant Care Home 23 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (23), Old age, not falling within any other of places category (22) St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered to provide personal care for service users of both sexes Whose primary needs fall within the following categories Old age, not falling with in any other category (OP) (23) Dementia - Over 65 years of Age (DE[E]) (23) Date of last inspection 24/01/06 Brief Description of the Service: St Marys Care home provides personal care and accommodation for 23 older people. At the time of inspection 19 residents were accommodated at the home. St Mary’s Care home is owned by the Broadoak Group that is a company which provides care for older people in Nottinghamshire and some of the surrounding counties. St Marys is a large converted vicarage situated on the main road in the village of Blidworth Nottinghamshire, fairly close to local amenities. All the bedrooms are furnished in a similar style and well appointed, many of these are well personalised. Six of the bedrooms have en-suite facilities. Most of the rooms have views over the rolling countryside. The lounge areas are situated on the ground floor of the home both lounge areas overlook the garden areas. Car parking is available. The current weekly fees are as follows; £277 older person, £319 highly dependant older person. This information is made available on the point of enquiry. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the site visit an analysis of the performance of the home over the previous year took place in line with the key national minimum standards. The evidence gained was assessed and thus the site visit planned in accordance with further evidence required to demonstrate compliance with the national minimum standards. One inspector undertook the site visit over course of three and a half hours. The main method of gaining evidence during the site visit was case tracking, this is a method of sampling the records of three randomly selected service users to ascertain if the needs of service users are appropriately assessed and identified needs are being catered for by the home to maintain optimum health and wellbeing of the service user. Five service users were spoken with so as to give the inspector an insight into the conditions and standards within the home. Those spoken with were happy with the staff, care received and the standards within the home. The assistant manager and regional manager assisted in the inspection process and two members of staff were spoken with. Staff were able to demonstrate an understanding of service users needs and the core values and principles in relation to their job role. What the service does well: What has improved since the last inspection? St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 6 Care plans have improved to ensure all complex needs are documented in the plan of care ensuring service users needs are met. Relevant assessments with the exception of risk assessment have now been completed thus ensuring service users needs are further identified. Medication policies and procedures have improved to ensure service users are protected. The rear fire exit door has been repaired; ensuring service users are further protected. The dining and adjacent seating area along with several corridors has been redecorated ensuring a more comfortable and pleasant environment. The sluicing facilities have been readdressed ensuring service users are further protected. Further members of staff have attained the national vocational qualification ensuring service users are in safe hands. Staff are working towards ensuring all mandatory training is completed ensuring staff are trained and competent to do their jobs. The alarm cord in the lounge has been repaired ensuring service users have a means to call upon staff when needed. What they could do better: It is required that service users have relevant risk assessments in place with regards to highlighted risks to ensure they are fully protected. Service users reviews are required to be service user focussed to reflect care and condition to ensure continuity of care. No member of staff is to commence employment without satisfactory checks being in place to ensure service users are protected. Arrangements for the commencement of the refurbishment of the outside windows and rusty ironworks is to be forwarded to the commission for social care inspection to demonstrate the intention to ensure service users live in a well maintained environment. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 7 The responsible individual is required to ensure all staff undergo appropriate induction on commencing employment to ensure service users are in safe hands at all times. All staff employed are required to have the relevant documentation as listed in schedule 2 in place to ensure service users are fully protected. Instruction is required with regards to the intentions of recruitment for the manager’s position to ensure a person who is fit to be in charge runs the home. Further evidence to demonstrate that quality assurance takes place within the home is required to substantiate that the home is run in the best interest of service users. Evidence that of the yearly gas certificate and the hoist contract is to be forwarded to the commission for social care inspection to demonstrate service users are protected. Ensure water outlet temperatures are recorded and a risk assessment is in place to ensure service users are protected. 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. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 8 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 St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 9 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 The quality rating for this outcome area is good. Service users may be assured their needs will be assessed and met prior to admission. EVIDENCE: The assistant manager visits prospective service users in the community prior to admission. Service users may also visit the home. Within case files examined there was evidence to demonstrated that assessments take place and these cover the requirements of the standard. Social worker assessments were also available. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 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 The quality rating for this outcome area is adequate this judgement was made using evidence available including a visit to the service. Service users health, personal and social care needs are set out in a plan of care, however further attention is required in respect of ensuring appropriate risk assessments are in place to ensure service users are protected. Further development is required with regards to service users reviews to ensure they are service user focused to reflect care and condition and ensure continuity of care. Service users health care needs are met. Service users are protected by the homes medication polices and procedures. Service users feel they are treated with respect and their rights to privacy is upheld. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 11 EVIDENCE: Service users undergo various assessments with regards to manual handling, the activities of daily living, nutrition and pressure area care; information gained underpins the plan of care. Risk assessment forms were also in place, however within the three files examined these had not been completed despite risks being highlighted. The regional manager and inspector observed three other case files within which risk assessments were available. Care plans in place were of a holistic nature and reflected service users personal preferences and choices. Daily records were maintained and information of significant events was available. There was evidence that reviews were taking place, however this was dates only and did not reflect what had been discussed or whether care had changed. Service users spoken with spoken highly of care received and stated that their needs were met. Staff spoken with were able to discuss the core values and principles and service users needs. There was evidence within service users files to demonstrate that the multidisciplinary team and other specialist services are accessed as required. Relevant equipment is gained via the district nurses and there was evidence that this was available within the home. One service user spoken with stated that the doctor would be called any time needed. Those service users case tracked medication records were observed, these corresponded with the prescription. Appropriate policies and procedures were in place and all hand written entries are signed by two staff. An up to date British national formulary is now available. Service users may use their own rooms or the dining area should privacy be required. All consultations are carried out in a private setting. That assistant manager stated that staff are instructed on maintaining service users privacy. One service users spoken with stated that staff are respectful and privacy is maintained at all times. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 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 The quality rating for this outcome area is good this judgement was made using evidence available including a visit to the service. Service users are enabled to find the lifestyle-experienced matches their expectations and preferences. Service users are enabled to maintain contact with relevant others. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 13 EVIDENCE: Staff facilitate activities with service users as they wish and as time allows. Activities may be on a one to one basis or in a group. One service user spoken with substantiated that they join in activities when offered, whereas another stated they did not wish to join in any activities. Staff were observed to spend time talking with service users. Both staff and service users stated that the routine of the home is flexible and service users may choose when they get up and retire and how they spend the day. Service users spoken with spoke highly of staff and one stated that they could have a laugh and a joke and staff remained respectful at all times. There are no restrictions imposed on visiting, which is stated in the homes policy. This policy is discussed prior to service users being admitted in to the home so they are fully informed. Although there is no specific private room there are a range of seating areas throughout the home, which could afford privacy if required. In addition to these areas service users may also use their own rooms or the staff office. Service users spoken with stated that visitors are made welcome and may visit at any time. The local vicar and entertainers visit on occasion and special events. Some service users also access the town and local facilities with assistance. Service users spoken with stated that they are able to make choices with regards to their daily lives and staff were respectful in regards to this. Although advocates are not in use at present staff are aware of how to access them if required. No service user is able to handle their own personal finances at present; a safe holding facility is available. Service users rooms are personalised and they may bring in personal possessions should they wish. Staff were able to discuss how equality and diversity is acknowledge within the ethos of the home. The kitchen was clean, tidy and well organised. Relevant records were observed and were completed as required. A wholesome and appealing diet is on offer and choices are given at each meal. Service users spoken with stated that food was at a good standard and choices are offered. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 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 The quality rating for this outcome area is adequate this judgement was made using evidence available including a visit to the service. Service users and relevant others may be assured that complaints will be listened to taken seriously and acted upon. Service users are protected from abuse, however further attention is required in regards to ensuring all staff employed have a satisfactory criminal record bureau check in place. EVIDENCE: Relevant policies and procedures are in place with regards to complaints. There have been no complaints received since the last inspection. Service users spoken with were happy with care and expressed no complaints. Staff spoken with were able to discuss the complaints procedure and how they would deal with complaints should they arise. An appropriate policy with regards to adult protection is in place. All staff have undertaken the training in adult protection and are awaiting certification. All staff employed have criminal record bureau checks in place with the exception of one member of staff. For this member of staff a criminal record bureau check had been sent for but not yet obtained, no references has been obtained, therefore head office was contacted and a POVA 1st was immediately requested and a supervisory programme discussed in regards to supervisory practice. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality rating for this outcome area is adequate this judgement was made using evidence available including a visit to the service. Service users live in a safe satisfactorily maintained environment, although further attention is still required to the exterior of the home. The home is clean, pleasant and hygienic. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 16 EVIDENCE: Routine maintenance is carried out when needed. The regional manager stated that plans are underway to address the previous requirement with regards to the outside of the building, the Commission for Social Care Inspection are to be informed when this is due to commence. The fire door has now been repaired. The dining and attached seating area has been redecorated as well as some corridors. The laundry room was observed and contained two dryers and one washing machine. There were hand-washing facilities available and the assistant manager discussed the current sluicing facilities. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality rating for this outcome area is adequate this judgement was made using evidence available including a visit to the service. The numbers and skill mix of staff meets service users needs. Staff are working towards ensuring service users are in safe hands at all times, however further attention with regards to the induction programme is required. Service users may be placed at a degree of risk due to the recruitment policies and practices. Staff are trained and competent to do their jobs. EVIDENCE: The duty rota was observed and demonstrated that sufficient staff are employed to meet service users needs. The skill mix is taken into consideration when planning the duty rota. Staff spoken with stated sufficient staff were employed to fully meet service users needs. Service users spoken with expressed no concerns with regards to the availability of staff. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 18 Two members of staff have attained the National Vocational Qualification level three, three have attained level two and 8 are working towards level two. The induction programme remains as previous however additional documentation has been located and the assistant manager is to implement this. Two new members of staff spoken with stated that they had undergone an induction; one stated it was adequate whereas another felt it could be improved upon. Four staff personal files were observed, two files did not have references available, however staff had been employed for a long period of time. Two did not have photographic identification in place. One member of staff had been employed without a POVA 1st check or any references being in place, the assistant manager stated that she knew this person and she had a satisfactory criminal record check form her previous employer. This was discussed with the regional manager and assistant manager and the conditions with regards to supervisory practice that needs to be put into place. Head office was contacted with regard to the POVA 1st so this may be accessed immediately as a criminal record bureau check had been sent for. The routine with regards to mail delivery is to be changed to enhance the process of receiving criminal record checks more effectively. Staff have undergone the majority of mandatory training and are awaiting certification. Further training is planned for the near future to cover any deficits. Each member of staff have an individual training file in place to substantiate this. Staff spoken with stated they felt supported in their job role. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 19 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 The quality rating for this outcome area is adequate this judgement was made using evidence available including a visit to the service. Service users live in a home, which is run and managed by a person who is of good character and able to discharge her responsibilities, however further instruction is now needed with regards to the intention of recruitment for the managers position. The home is run in the best interest of service users; however further evidence would fully substantiate this. Service users personal finances are safeguarded. The health safety and welfare of service users and staff are promoted however they may not be fully protected due to the noted deficits. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 20 EVIDENCE: There is currently no manager in place; therefore two assistant managers with the support of the regional manager are running the home. The senior assistant manager has worked at the home for fourteen years and assisted in the inspection process. She was able to demonstrate a commitment to maintaining high standards of care and overseeing the general management of the home. She has attained the national vocational qualification level two and ensures she remains up to date with mandatory training. The assistant manager carries out quality assurance on an informal basis, however there was no evidence available to demonstrate this. Within service users files there was evidence available to demonstrate that service users had completed quality assurance questionnaires just over a year ago. Three service users personal allowances were checked and corresponded with the accounting sheet. Two staff sign for all transactions and receipts are kept. No one at the home is responsible for service users finances. All maintenance certificates with the exception of the yearly gas testing and the hoist contract were observed. Accident records recorded significant events and contained appropriate information. The fire alarm and emergency lights were tested as required. Water temperature had not been recorded, the assistant manager was not aware of this therefore the regional manager stated that she would assist in ensuring this was implemented. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4,c) Timescale for action Ensure relevant risk assessments 16/07/06 for all identified needs are in place with regards to highlighted needs. Service users reviews are require 16/08/06 to be service user focussed in order to reflect care and condition thus enhancing the continuity of care received. The responsible individual is required to inform the commission for social care inspection once the POVA 1st has been obtained for the named member of staff and a copy of the supervisory programme to be put into place is to be forwarded to ensure service users are protected. Arrangements for the commencement of the refurbishment of the outside windows and rusty ironworks is to be forwarded to the commission for social care inspection. 20/06/06 Requirement 2. OP7 15(1,b) 3. OP18 19(1,a) 4. OP19 23(2,b) 16/07/06 St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 23 5 OP28 18(c ) 6 OP29 19(1,a) 7. OP31 8(1,a) The responsible individual is 16/08/06 required to ensure all staff undergo appropriate induction on commencing employment. All staff employed are required 16/07/06 to have the relevant documentation as listed in schedule 2 in place. Instruction is required with 16/07/06 regards to the intentions of recruitment for the manager’s position. Provide further evidence to demonstrate that quality assurance takes place within the home. Evidence that of the yearly gas certificate and the hoist contract is to be forwarded to the commission for social care inspection to demonstrate service users are protected. Ensure water outlet temperatures are recorded and a risk assessment is in place. 16/08/06 8. OP33 24(1) 9. OP38 23 23/06/06 10. OP38 13(4a,c) 23/06/06 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 OP33 Good Practice Recommendations To complete and forward to the commission for social care inspection monthly regulation 26 forms. St Mary`s Care Home DS0000008816.V288118.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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