Inspection on 24/03/09 for The Elms

This inspection was carried out on 24th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Elms 14/11/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Elms 34 Elmgrove Road Gorleston Great Yarmouth Norfolk NR31 7PP     The quality rating for this care home is:   two star good 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: Ruth Hannent     Date: 2 4 0 3 2 0 0 9 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. that people have said are important to them: They reflect the things 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 Older People 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 Older People Page 2 of 25 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 Older People Page 3 of 25 Information about the care home Name of care home: Address: The Elms 34 Elmgrove Road Gorleston Great Yarmouth Norfolk NR31 7PP 01493657069 Telephone number: Fax number: Email address: Provider web address: irenebeck@btconnect.com Name of registered provider(s): The Elms Residential Care Home Ltd care home 21 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service: Care Home - PC to service users of the following gender: Both whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - code OP Date of last inspection Brief description of the care home The Elms is a converted property registered as a care home to look after 21 older people. It is situated in quiet street in Gorleston near Great Yarmouth. Since the previous inspection in May 2007 there has been a change of proprietor who is now Mr Paul Godfrey. Care Homes for Older People Page 4 of 25 Over 65 21 0 Brief description of the care home The premises are over two storeys with access to the first floor by a shaft lift. The accommodation consists of 18 single occupancy bedrooms as double rooms have now been changed to singles. The home has an enclosed garden surrounding the building, with a small area at the front for parking. The fees in the home range from 299 to 358 pounds. Care Homes for Older People Page 5 of 25 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection report has been completed following a visit to the home. Prior to this evidence has been looked at that includes the Annual Quality Assurance Assessment (AQAA) that was completed by the Manager, comments received from residents, notifications received at CSCI and any comments that had been received at the Commission from any stakeholders involved with The Elms. In total 8 comment surveys had been sent to the Commission. Only two notifications over the last year had been received from the home giving information on people who had passed away. No complaints or concerns had been received. Residents and staff were spoken to and time was spent observing the day to day routines in the home. Care Homes for Older People Page 6 of 25 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 Older People Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Potential residents do have a clear picture of the service offered and have all the necessary information to ensure the home is suitable for them. Evidence: The home has an up to date statement of purpose and service users guide that was available in the entrance and in the residents rooms on arrival to the home. The details are easy to read and give a picture of the service available. Some residents had commented in the surveys sent by the Commission that they did not have a contract. The files were looked at and copies of all contracts were seen. The Manager explained that some residents families have the contracts and residents are not always aware. The process of assessing potential residents was discussed with the Manager. The details of each possible resident is sent to the home and then both the Manager and Care Homes for Older People Page 9 of 25 Evidence: The Deputy visit the person. They have a written format of standard questions that give a guide to the needs of the person. The home is not registered to accept people who have dementia and the Manager makes that clear to potential customers. People are encouraged to visit the home and each resident is offered a 4 week trial to ensure that they wish to stay and that the home can meet their needs. One resident spoken to told us of the support and encouragement she was receiving in the few weeks she had been in the home. My walking is so much better already. The staff support me well. Care Homes for Older People Page 10 of 25 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 does ensure the full heath care needs are recorded and met with dignity and privacy. Evidence: The home has care plans for each resident kept in a locked drawer in the office. In each residents rooms there is a detailed plan of need for staff to follow that has been collated from the original care plan. The details of the care plan reviews were typed and in the folders. The details read showed how the resident had been involved especially where there have been concerns that have meant extra meetings have had to be held. The Manager also gave clear details of the involvement where possible of the families in the care plan reviews. The health care needs for residents are met who are registered with various surgeries. The details of all transactions with the G.Ps are typed up as the Manager has a system in place that all requests and information via the G.P. is done in letter format. The most recent letter was seen and asking for confirmation on a medication being temporary of permanent. Each resident has a monthly weight check and of the three Care Homes for Older People Page 11 of 25 Evidence: care plans seen the weights were of no concern with all appearing fairly stable. The Manager tells us in the AQAA that regular access to dental, chiropody and optical services are available. One resident spoken to confirmed that any appointment required is set up for any resident. The homes medication is stored in a locked trolley in a spare room by the office. The trolley was looked at inside and all the medication was in a blister pack system supplied by boots. There was only a few loose bottles and packets that had individual names on and dates the packet had been opened, as noted on eye drops. The medication administration records (MAR) sheets were looked through and all signatures were completed for any medication that had been administered. Each residents photograph was on each chart except for the person most recently admitted and, according to the Manager, this was being developed and should be on the records soon after the inspection. The trolley is bolted to the wall and is stored safely. All staff who administer medication are trained through Boots. The manager informed us that only the Manager, Deputy and Seniors are responsible for the administration of medication. Throughout the day staff were observed carrying out there duties in a respectful manner. The residents were assisted for any personal care tasks in private and when assisted the doors were knocked upon and staff asked if they could enter. Family comments in the surveys received at the Commission tell us of the respect the home gives to there loved ones. Care Homes for Older People Page 12 of 25 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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 day to day lives of residents are suitable for the individuals and matches their expectations. Meals are well balanced and enjoyed but more choice and reminders would make the mealtime experience even better. Evidence: The home has now a designated activities organiser covering a few hours a week. The residents and staff tell us of a wide range of group activities such as armchair exercises and bingo to outside entertainment coming into the home. On the day of this visit one resident was in charge of selling raffle tickets for the forthcoming fund raising event. The resident spoken to enjoys helping raise money to ensure they have trips out in the summer or have entertainment in. The conversation gave a good picture of how this person was empowered to be involved in the homes daily life. During the morning the residents were having fun with word games, another person was reading and those who decided to stay in their rooms were occupied with the paper or the television. Apart from one person the residents all appeared happy, smiling and full of praise for the home. Care Homes for Older People Page 13 of 25 Evidence: One person talked of his religion and how he is able to get to his special church every week. This appeared very important to this gentleman and the home does support this resident with their religious beliefs. Families and friends are encouraged to the home, and the visitors signing in book showed regular people visit the home. The comment surveys received from the residents had been shared and completed by a lot of family members who all gave positive comments. The Manager also talks in the AQAA of the designated cordless phone available for residents to be able to contact their families and friends in private if they so wish. On the day of this visit the residents had a choice of meat pie with vegetables or fish cakes. The meal was presented well and appeared hot and was enjoyed by the residents. Some were eating in the dining room, some in their rooms and one in the lounge. The meal was presented on the plate all together with no choice of how much each person would like or how much gravy they wanted. (One person had gravy put on their dinner that they do not like). It would be more empowering if residents had vegetable dishes and jugs for them to make a decision as to how much they wanted on their plate for that meal. The meals are chosen by the residents on a daily basis with the cook visiting each person to check what they would like on that day. The menus are on display in the kitchen but on asking residents the meal chosen had been forgotten. To help aid memory it would be encouraging to see large print menus on the tables or on display on the notice boards to jog peoples memories. Fresh fruit was placed in bowls around the dining room allowing anyone access to fruit as and when they would like. It was also noted that lots of drink was available at all times to ensure residents were drinking plenty of fluids of their choice. Care Homes for Older People Page 14 of 25 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 people involved with The Elms can be assured that there complaints will be listened to and acted upon. Procedures are in place to protect and safeguard residents from abuse. Evidence: Of all the 8 surveys received from the residents in the home 7 said they would know how to complain. The details on how to complain are in the service users guide and on talking to three residents they all stated they would have no problem in talking to the manager or Deputy Manager if they had any concerns. The Commission has not received any complaints about the home from anyone involved with the service. The Manager gave as full account of how a staff member had whistle blown with a concern that did lead to a person being dismissed. The details of the events were shared and the outcome was deemed appropriate. Two staff members were spoken to and both understand their duty to whistle blow and all staff have had training in adult abuse. Records are held on the computer of this training and was confirmed by other staff members on duty on the day of this inspection. Three personnel files of staff also showed that no one commences work without a POVA first and then CRB check in place prior to starting their employment. The Manager also tells us in the AQAA that more comprehensive policies and procedures have been introduced on recruitment, complaints and whistle blowing. Care Homes for Older People Page 15 of 25 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable, safe and fairly comfortable for the number of residents in the home at present Evidence: This home is an adapted house and bungalow that has over the years been altered. The new proprietor has had plans completed to have the home extended and the attic space converted. At present the home is in a poor decorative condition with only limited work, at present, being carried out, such as painting a room ready for a new occupant, while the alterations are taking place. Fire records were seen that showed a regular weekly alarm check is carried out. This was confirmed by one of the residents. The fire extinguishers are serviced with a date of August 09 for the next service seen. The Manager also read out the names of the contractors that service equipment regularly and who are the contractors for the main supplies to the home. There were two hoist seen to assist residents on each floor and these are serviced every six months as stated by the Manager. The dates were noted on the equipment and both are due for another service on the 5th April 2009. The bathrooms are in need of refurbishment with tiles cracked in some areas and one bath not used at all except to clean commodes in. Some bedrooms are in a poor decorative condition with ceilings flaking and walls and doors chipped. The rooms are Care Homes for Older People Page 16 of 25 Evidence: made homely with individual pictures and personal possessions. Nice bed covers are in place and people spoken to are happy with their rooms. The Manager told us she has offered bigger rooms to residents who are in smaller rooms, at different times, but they are wanting to stay where they are. The main kitchen has been updated in the last few years but, although requests from the home have been written to the Environmental Health Officer, no one has been to see the kitchen so no report was available. The main lounge and dining room is limited in size and if an extension is being considered more communal space would be required. On looking at the dining room, if all 18 residents wished to eat in there, it would be very tight for space. At present, some people prefer to be in their rooms for meals so the problem is not there at present. This room is light and fresh with nicely laid tables and fresh fruit and flowers around. At the top of the stairs there is a stair gate that has been placed to ensure one resident uses the lift for safe passage to the downstairs. The Manager has not completed a risk assessments for this person to date and needs to include the risk of this stair gate as part of the residents risk assessment. Clearer more detailed day to day risks that have been assessed for individual residents should be made clearer in the care plans. The garden has been cleared ready for the building works to begin and the grounds then to be landscaped. At present the gardens are unsuitable for residents but, according to the Manager should be accessible for the summer as the residents have already got nice garden furniture to go out there. We toured the home and looked in many rooms and shared bathrooms. Everywhere was very clean and tidy with no unpleasant odours detected. The home has a very comprehensive carpet cleaner that is in regular use. On the day of this visit the Deputy Manager was doing the cleaning as the main cleaner was off for the day. Care Homes for Older People Page 17 of 25 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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 has suitable and correctly recruited staff who are trained and support the residents competently and timely. Evidence: On the day of this inspection visit the home had 2 care staff on duty, 2 Managers and 1 cook. The Manager and Deputy Manager share the 7 day a week management cover and also help the carers, cook and cleaner when required. The home only takes 18 residents at present, although it is registered for 21, as double rooms are now all used as singles. Throughout the day staff were observed and spoken to carrying out there tasks. No one was rushed, everyone appeared to be smiling and all residents spoken to stated that staff help them when they need assistance. The Manager informed us that quite a number of the residents can manage a lot of their own care and only require minimal assistance. Through observation and on talking to residents the staffing levels appear suitable for the needs of the residents living at The Elms at present. The 2 staff on duty spoke of their NVQ qualifications with pride. The next step they are planning is for the NVQ3. The Manager informs us in the AQAA that 80 of staff are NVQ qualified and that plans are now underway for the ancillary staff to also gain the qualification. Care Homes for Older People Page 18 of 25 Evidence: At this visit 3 personnel files were looked at. All seen had the appropriate paperwork such as references, a contract, POVA first and CRB, identification and an application form. The staff spoken to talked of the support and assistance they received when they started in the home 2 years ago. In the office is the records of the Skills for Care induction booklets that have been completed by all new staff and also the individual booklets that are completed on statutory training such as infection control, food hygiene and understanding medication. The Manager has a training matrix held on the computer to ensure that staff do not miss a training required. Through discussion it was noted that to date the staff have not had training in the Mental Capacity Act and the Manager is to plan this for the future to ensure all staff are aware of the implications of this Act. Staff meeting minutes for the past few meetings were seen with the last date of the January 09 read and the staff who attended, listed and seen. Care Homes for Older People Page 19 of 25 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 manage by a competent and capable person who ensures the home is run in the best interests of the residents but who could improve the areas of health and safety. Evidence: The Manager of this home has worked at The Elms in various job roles for a number of years. She and the Deputy Manager work as a team to ensure the home has management cover over the seven day period. Both appear to compliment each other with how tasks are carried out. Decisions are made jointly and both turn there hand to any task that needs to be done. Both have achieved the NVQ 4 Registered Managers Award and regularly up date their own training to cascade to the staff. Through discussions on the day of this inspection and talking to staff and residents it appears that the Manager is very supportive and is able to carry out her role fully. The Manager showed examples of questions asked to measure the quality of the service and the last one seen was for August 2008. The plans for 2009 are to include Care Homes for Older People Page 20 of 25 Evidence: questionnaires for the staff to complete. The surveys sent by the Commission that had been completed prior to this visit (8 in total) all praised the home for the care given with only one person who was not so happy with the area around meal quality. This was discussed with the individual and the Manager is trying to work with this person to ensure they enjoy their meals. The home does have a safe for holding residents personal money that is in the Managers Office. The Manager was able to give details of the procedure for managing the money. The only key holders to the safe are the Manager, Deputy Manager and the Owner. Each person has an envelope with their money in. A receipt is issued for any money received. All purchases are recorded and receipts obtained. The Manager does try to encourage people to be responsible for their own money, if after assessment they are found to be able. Staff supervision does take place and records of these sessions were seen in the personnel files. The 2 staff spoken to also said they can talk to the manager at any time and do not have to wait for the formal meeting. The records do show that these sessions are every three months but the recommendation in the Care Homes For Older People, National Minimum Standards is 6 times per year. The home has records of all the health and safety training that has taken place and ensures that all staff are up to date with moving and handling and fire training. Through observation it was clear staff had the understanding of how residents should be assisted with transfers. All the names of contractors involved in the home were shared with us to show servicing details and maintenance of equipment. The home does ensure chemicals in the building are stored correctly but do not have available any safety data sheets in case of accidents in the home. There also needs to be risk assessments in place for all working practices and records of these assessments available for inspection. Care Homes for Older People Page 21 of 25 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 Older People Page 22 of 25 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 1 19 13 The home should ensure any 01/05/2009 potential risk to the health and safety of residents is identified and risk assessed. To ensure all areas of potential risk have been identified to protect, as much as possible, the residents and staff. 2 38 13 Safety data sheets for all chemicals in the building should be available for all staff. To ensure safe working practices are applied if an accident occurs with chemicals. 01/05/2009 3 38 13 The home should have risk assessments in place to show that as far as reasonably practical the home is free from hazards. 01/06/2009 Care Homes for Older People Page 23 of 25 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 To have procedures that promote health and safety for all residents and staff 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 15 The residents could have even more choice if vegetables and gravy or puddings with custard or cream were in separate containers for people to help themselves to the quantities they prefer. Large print menus on the tables or/and the notice boards would act as reminders and prompts to residents throughout the day. Shared facilities are limited and more space should be consider if the extension is going ahead. Staff supervision is recommended to occur 6 times a year. 2 15 3 4 20 36 Care Homes for Older People Page 24 of 25 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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