Inspection on 12/12/06 for Swallow Wood Care Home

This inspection was carried out on 12th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Swallow Wood Care Home 21/11/07

Swallow Wood Care Home 03/01/06

Swallow Wood Care Home 23/03/05

Swallow Wood Care Home 06/10/04

Swallow Wood Care Home 18/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Swallow Wood Care Home Wath Rd Mexborough South Yorkshire S64 9RQ Lead Inspector Janet McBride Key Unannounced Inspection 12th December 2006 8:50 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 Swallow Wood Care Home DS0000015875.V315175.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. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swallow Wood Care Home Address Wath Rd Mexborough South Yorkshire S64 9RQ 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) 01709 571477 01709 585505 swallowwood@trinitycare.co.uk Trinity Care Ltd Leonie Shepherd Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability over 65 years of age of places (38) Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. One specific service user under the age of 65, named on variation V8248 dated 9th June 2004, may reside at the home To admit one named person under the age of 65 in need of nursing care One specific service user under the age of 65, named on variation V31609 dated 24th May 2006, may reside at the home 3rd January 2006 Date of last inspection Brief Description of the Service: Swallow Wood Care home was purpose built and is registered with thirty-eight beds. The home is situated on the main Mexborough road within a residential area to the west of the town centre of Mexborough, shops and amenities are close by. Accommodation is provided on two levels, the upper floor being serviced by a shaft lift, and there are several lounges situated around the home on both floors. The home is set in enclosed gardens, comprising of shrubs, mature trees, lawn and patio area which has suitable access for service users either on foot or in a wheelchair. Car parking spaces are available at the front of the home. The home trades has Trinity Care plc, which is part of the Southern Cross Healthcare group The company was founded on and continues to be managed in accordance with Christian principles but is not aligned to any one denomination. Residents admitted do not have to be practicing Christians. Fees range from Nursing Care £344 - £430 plus free nursing band. Residential Care £ 329 - £375 per week, as of December 2006 additional charges are made for hairdressing, Chiropody, Optical, Dental services, specialised toiletries, and magazines. Information about the service is available to residents and their families via the home’s Statement of Purpose and the Service User Guide. The last inspection report was available on the homes notice board. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this Key Unannounced Inspection, which took place on the 12th December 2006 for 7: 35 hours. The home is registered for 38 beds; at the time of inspection 34 residents were residing in the home. Pre-inspection work was carried out for example, analysis of notifications, complaints and other relevant documentation. During the inspection documentation and records were examined for example, medication, complaints, accident records, staff rotas, staff training files and case tracking of three residents care plans, these were cross-referenced with other relevant documentation relating to those residents. Information was gathered from as many different individuals as possible, for example individual interviews with members of staff, including the manager. Discussion with some of the residents and feedback from two visitors on the day. Ten comment cards were sent out to residents prior the inspection and Six were received back their comments are included in the report. A tour of the premises and direct observation of staff interaction with residents was carried out throughout the inspection. The inspector would like to thank all the staff and residents for their cooperation in the inspection process, and any issues or concerns that were raised were discussed with the manager and operations manager at the end of the Inspection. What the service does well: The home provides a welcoming and comfortable environment, with a relatively stable staff team who are motivated towards potential providing good quality care. The home provides information residents and their relatives are invited to look around the home and spend up to a day there before being admitted. Those residents spoken to during the inspection “said they feel they are treated with respect by the staff” and enjoy living at the home. The staff encourage relatives and friends to visit the home and maintain links with residents. The company continues to invest in the home to freshen it up, and to keep it looking inviting for residents and potential residents. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Swallow Wood Care Home DS0000015875.V315175.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 Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. Quality in this outcome area is Good. This judgement has been made using the available evidence in records, interviewing staff, residents and visitors on the day. Residents were fully assessed prior to moving into the home, with other professionals involved if needed, this ensured that residents care needs were met, by staff who had the skills to deliver the appropriate care needs. EVIDENCE: Residents had a service users guide, which informed them of accommodation and gave a description of the services provided. The manager said that the home has a condition of registration relating to an under 65 years of age resident that is no longer applicable. The home had applied to have this condition removed from their registration certificate. All residents were issued with a contract/statement of terms and conditions, and these contracts were examined of those residents that were case tracked. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 9 Scale of charges within the home was discussed with the manager and any extras that residents had to pay for, all of which is documented in this report. Records showed that residents had a full needs assessment prior to being admitted to the home, this ensured that the home could meet their needs, and any specialised needs were provided as required. To inform the prospective resident and their relatives that the home could meet their needs, they are invited to look around the home and spend up to a day there before being admitted. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and10. Quality in this outcome area is Good. This judgement has been made using the available evidence in records, talking to staff and a visit to the service. Residents receive health and personal care based on their assessed individual needs; they are referred to any specialist services when required. Risk assessments and medication records were not fully up to date; staff must pay greater attention to these issues. EVIDENCE: Three care plans were case tracked and cross-referenced with medication and other relevant documentation relating to that resident. Records examined and discussion with the staff confirmed resident’s healthcare needs are assessed and set out in a plan to enable staff to deliver the care required. All plans were very detailed and included evidence that specialist services were involved. All contained various assessment including risk assessments, with Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 11 the exception of one, this resident did not have a risk assessment or care plan for aggression, daily records indicated they had out bursts of aggression on a regular basis. Although staff were aware of these issue, this left new staff and residents vulnerable because the appropriate safeguards were not in place. Residents had access to all health care services; and evidence available showed that, residents are referred to other health professionals when required professionals e.g. tissue viability, continence advisor and learning disability nurses. The nurses were able to carry out nursing requirements for those residents who fall into the nursing category, and district nurses attended to carry out any procedure, for the residential clients, e.g.injections or take bloods. All residents had nutritional assessments completed and weighed on a regular basis, which was either weekly or monthly. Residents had access to dental, optician and chiropody services when required. Accident records were examined and records showed that staff complete appropriate documentation, these reports were analysed by the manager on a monthly basis. Medication records were discussed with the manager and the nurse in charge at the time of inspection. Policies and procedures were in place, nurses have responsibility for administering medications within the home, none of the residents self medicate. The home had arranged for the collection of waste medicines, with records kept. An audit of the records and stock checked during the inspection were all found satisfactory, with the exception of some hand written medication records These must have two signatures to verify prescribed medicine. Those residents spoken to during the inspection said they feel they are treated with respect by the staff and confirmed that they receive any personal care in private. During the inspection there were many examples of good practice, staff were observed to knock on bedroom doors before entering and interaction with the residents was good addressing them by using their preferred name as stated in their care plan. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is Good. This judgement has been made using the available evidence, interviewing staff, residents including observation at mealtimes. Residents received a wholesome and appealing balanced diet with a varied selection of food available. Residents spend their day with opportunities for social activity for residents to participate in if they wish, routines were flexible. EVIDENCE: Observation during the inspection found the home had a relaxed atmosphere Staff were observed interacting with residents throughout the inspection. Residents said their daily routine was flexible and varied, they confirmed they were able to choose how they spent their day and what leisure activities to join in with. An activities co-ordinator who works 21 hours per week and is assisted by another carer for 1 day per week a total of 28 hours per week of activities is provided to arrange various activities in and out of the home. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 13 There is an activities board on display to inform residents of what has been arranged for every day of the week; on the day of inspection a church service and carols took place. Discussion with both the residents and the activities co-ordinator confirmed that residents enjoyed the activities available. Some residents choose not to participate in the activities but really appreciated being read to by Carol the activities organiser. Books and daily newspapers available to them, some liked to watch television and others liked to spend time in their bedrooms. Visitors were seen to come and go during the inspection, they are allowed to visit at any time. Discussion with one person who was visiting a friend, spoke very highly of the staff and the facilities at the home. The home tries to keep links with the local community, via residents visiting local shops, garden centres and meals out to local venues. The manager said that children come into the home from local schools especially at this time of the year to sing Christmas carols, also the Salvation Army and local church visit on a regular basis. Residents are encouraged to make choices, about many aspects of their daily lives, the comments received during the inspection were consistently positive. Information is provided for residents and families how to contact various external agents for example, advocates, Age Concern, dementia groups and social services. At lunchtime residents were able to enjoy their meals in an unhurried manner; the atmosphere was relaxed some residents sat in lounge chairs with tray tables saying this was their choice they did not want at sit at the table. Staff were seen to give assistance to those who needed it. Menus seen offered a varied diet, meals were well presented, looked and smelled appetising. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is Good. This judgement has been made using the available evidence in records, interviewing staff, residents and visitors on the day. The home had an appropriate complaints procedure. It was clearly written and accessible to staff, residents and their families. Adult protection policies, procedures and training for staff were all in place at the home. EVIDENCE: Complaints systems were in place and the pre-inspection questionnaire stated the home had received four complaints since the last inspection, these were discussed with the manager and records were checked. Records showed that these complaints were completely investigated, and stated what action had been taken with feedback to the complainants. Comment cards received and residents spoken to said they were aware of the complaint procedure and they felt able to raise any issues with the manager or staff. The home had policies and procedures for adult protection in place, there was also a protocol covering the monies and financial affairs of residents, including the administration of personal allowances to protect their interests. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 15 Training records showed that most staff had received abuse training, staff spoken to confirmed this and said they were aware of the homes polices and procedures, including whistle blowing policies and who to refer to. Referrals to adult protection was discussed with the manager, who stated one recent referral, was being investigated by the manager who will inform Commission for Social Care Inspection in writing of the action to be taken. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26. Quality in this outcome area is Good. This judgement has been made by a visit to the service talking to visitors and tour of the premises. The home was well maintained with renewal of equipment evident, this ensures that residents live in a safe and comfortable environment, with private space that allowed them to have their own possessions around them. EVIDENCE: All the communal premises were found to be clean and tidy and in good decorative order with ongoing general maintenance of the home taking place. Refurbishment to some of the fixtures and fittings had been carried out since the last inspection. The reception area of the home displayed the relevant insurance and registration certificate .The information board contained lots of valuable information for residents and relatives including the menu for the day and the activities that had been organised. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 17 Resident’s bedrooms were clean and tidy and confirmed that residents are able to bring their own personal possessions and memorabilia for their bedrooms, most bedrooms had been personalised by the resident’s families with photos and memorabilia. The home had purchased a number of new beds, six specialist beds for nursing residents, and new divan beds for residential residents. Residents had been provided with furniture and furnishings in compliance with their need and preference. Laundry facilities remain the same, the home has two washers and two dryers, the site was well organised and plenty of clean linen available. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is Good. This judgement has been made using the available evidence in records, interviewing staff and a visit to the service. Appropriate staffing and skill mix level were found, to meet residents care needs. On going development of staff to ensure they have the skills and knowledge to carry out their role. EVIDENCE: Staffing was discussed with the manager and duty rota examined, they had some vacant posts, and have used either bank or agency staff to ensure appropriate staffing numbers on duty. Interviews have taken place and they will be filling the relevant post as soon as possible. The staffing hours are determined by the dependency levels of residents, the staffing on the day was a trained nurse and 4 care staff for 32 residents, the manager is supernummary with relevant admin, activity person, domestic and kitchen staff also being on duty. Samples of staff files were examined, three files were checked, these were new staff at the home. It was evident that the home operated a through recruitment procedure, based on equal opportunities and ensures the Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 19 protection of service users; e.g. two written reference, gaps in employment checked, CRB and POVA checks completed, PIN and qualifications of nurses, and, ID documentation of each member of staff was also in the files. All staff had an individual training file, this was discussed with the manager and staff that were interviewed, copy of training record was also available. All this provided evidence of all training staff had completed including statutory training, and updates where required. NVQ training for staff was on going, 7 out of the 19 staff had completed their training at level 2 or 3. The manager commented that staff turnover impacted on the number of qualified staff available. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is Good. This judgement has been made using the available evidence in records, talking to staff and a visit to the service. Residents live in a home that is managed to ensure their safety and welfare are promoted and protected, records required by regulation and for their protection were maintained and up to date. EVIDENCE: Discussion with the manager about her role and her own development, confirmed that she is a registered nurse and is responsible for the day to day running of the home. She has gained her BA Hons degree in Health Studies and is continuing with the registered managers award. She also continues to undertake periodic training to update her knowledge, skills and competence whilst managing the home. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 21 I discussed a range of issues with the manager relating to management of the home for example equality and diversity within the service, the manager confirmed that a new policy is to be rolled out in the new year. Staff will be made aware of this and training will be given. The home does have equal opportunities criteria within the recruitment procedure; it does employ male and female staff. Quality audits within the service were completed and evidence was available for example regulation 26 visits were completed on a regular basis. Surveys are sent out on a monthly basis to residents and relatives. Evidence was available to show that monthly audits of accidents, pressure sores, medication and care plans were carried out, and any action taken if issues were found. Resident’s finances and monies were checked with the homes administrator, all found to be accurate and satisfactorily recorded, with receipts available. Staff supervision was a requirement on the last inspection; records showed that staff had received this at the required frequency, and staff spoken to confirmed they had received their yearly appraisals. Safe working practice was both observed and records checked, all of which was found satisfactory. Staff were aware of health and safety policy and procedures, records seen were all up to date and satisfactory, with up to date current certificates for the passenger lift and hoists within the home. Since the last inspection the home have obtain written authorisation from the Fire Service that their fire drills and evacuation policy are acceptable and safeguards the interests of all residents. Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (2)(b) Requirement Care plans and risk assessments must be in place for any identified issue that as been raised. Timescale for action 31/12/06 2 OP9 13(2) Medication, two members of staff 31/12/06 must sign hand written medication records sheets. Continue with on going NVQ training to ensure a minimum ratio of 50 of care staff are trained to NVQ Level 2 or equivalent is achieved. The registered manager achieves NVQ 4 in management. 31/03/07 3 OP28 18(1)(a) 4 OP31 9(2)(b)(i) 31/03/07 Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Swallow Wood Care Home DS0000015875.V315175.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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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