Care Home: Bethany

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What the care home does well People who live at Bethany were very happy with the service provided and relatives also responded very positively in surveys. The views and wishes of people who live at Bethany are central to how the service develops. Other people with an interest in the home, staff, trustees and relatives are also consulted and listened to. There is a very strong ethos of respecting individual preferences and wishes. Privacy and dignity is respected by all residents and staff. People are not admitted to the home until it has been established that the service will be appropriate for them and that it can meet their needs. The service helps people to maintain their health and provides support in an unobtrusive way to assist with personal care needs. Staff are fully committed in supporting people to lead purposeful and fulfilling lives as independently as possible. Staff are well trained and are employed in sufficient numbers to ensure that peoples collective needs are met. The home is very well managed. The manager ensures that she keeps up to date with developments in legislation, for example, The Mental Capacity Act and ensures that the service adapts accordingly. Quality assurance procedures are very good. What has improved since the last inspection? Risk assessments have been developed further to ensure that people are kept safe whilst maintaining as much independence as possible. Medication systems have improved and now staff can identify each individual tablet that they administer. Menus have been revised to reflect peoples preferences more accurately. The laundry system has changed as a result of peoples comments, now each person has an individual plastic box for their laundry This aims to stop any clothing going missing in the home. A weekly bus goes to a local supermarket as a result of peoples request for this service The environment continues to improve, some landscaping is taking place to enhance the view from some rooms and to provide an extra seating area. What the care home could do better: No improvements have been identified as a result of this inspection Key inspection report Care homes for older people Name: Address: Bethany Pamber Heath Road Tadley Basingstoke Hampshire RG26 3TH     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kathryn Kirk     Date: 2 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Bethany Pamber Heath Road Tadley Basingstoke Hampshire RG26 3TH 01189701710 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: bethanyhome@tiscali.co.uk Bethany Care Trust care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 37. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Dementia (DE) Date of last inspection Brief description of the care home The home is registered to provide care and accommodation to 37 elderly Christians any of whom could have dementia. Bethany is a large detached property set in spacious grounds in Pamber Heath, Tadley. The physical environment is of a high standard, with large attractive communal areas and the majority of bedrooms being single. The garden is large and well maintained, providing additional recreational space. Bethany Care Trust is the registered provider for Bethany and service users are encouraged to retain their own privacy. Care Homes for Older People Page 4 of 25 37 0 Over 65 0 37 Brief description of the care home 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: three star excellent 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: The inspection considered information received about the home since the last annual service review which we carried out in September 2008. This includes information provided in the Annual Quality Assurance Assessment (AQAA) which was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information. We visited the service in July 2009. The visit took place as a result of an application made to vary the conditions of registration to enable the service to admit people with dementia. This application was approved. We visited the service on 25 September 2009 as part of our key inspection. We looked at documentation relating to four people living at the home. We spoke to the registered manager one trustee, six staff members and five people who live the home. We also spent time in communal areas observing interactions between staff and service users. Care Homes for Older People Page 6 of 25 We looked at documents relating to staff recruitment and training, records of complaints, medication administration sheets and recent audits which had been undertaken. We took into account information provided by the service about significant events that have happened at the home over the past year Care Homes for Older People Page 7 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 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 9 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. People do not move into the home until their needs are known and the service is satisfied that it can meet them. Evidence: The AQAA says All prospective residents are offered respite care initially, but even if this is not possible or it is declined, every resident enters the Home on a trial basis. The manager completes a thorough pre-admission needs assessment and often consults friends/family/healthcare professionals with prior agreement by the resident. Copies of any healthcare assessments or care plans are obtained as part of the needs assessment to ensure that all needs can be met at Bethany prior to admission. Records we saw confirmed that the home completes a thorough assessment of peoples needs before they move in . People we spoke with said that when they first moved in staff asked a lot of questions about their needs and wishes and continued to do so. Care Homes for Older People Page 10 of 25 Evidence: There is a website and brochure available for more information about the home and each person has a service user guide Care Homes for Older People Page 11 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. Personal support is responsive to peoples varied needs and preferences. Residents are well supported to access health care services. Medication is well organised and is administered by trained staff. Evidence: The AQAA says Each service user has a comprehensive, person-centred care plan which has been based on thorough needs assessment, modified as soon as their needs change and reviewed regularly. Wherever possible the resident, and their relatives if appropriate, are fully involved in the care planning Records we checked during our visit confirmed that this information was accurate. At the last inspection, it was noted that although risk assessments were in place where an area of risk had been identified, some needed further development, for example, when bed sides were considered necessary. We saw that risk assessments have improved since then. Peoples capacity to understand the measures that have been taken to reduce risk are considered and relatives consent is obtained where this is necessary. Care Homes for Older People Page 12 of 25 Evidence: Each service user is registered with a local G.P immediately on arrival, unless they have lived locally and wish to keep their current G.P. New patient appointments are made as soon as they become available. The manager said that G.Ps are very proactive both in specialist referrals and respecting the wishes of residents. The AQAA says that As part of the care planning process, referrals are routinely made to continence advisors, opticians, chiropodists and dentists as necessary and in consultation with residents. Medical referrals are sought via the G.P for psychogeriatrician input if the psychological health of the service user is giving concern. Service users we spoke with agreed that they receive the personal and medical support that they need. One person described how staff ensured that he was provided with breakfast early to enable him to attend an outpatients appointment on time. Of the Relatives surveyed by the home, fourteen out of fifteen described the quality of care as excellent One person described it as good. Staff were observed to pass on information clearly to each other about what appointments people needed to attend and to discuss who would support them if this was necessary. The manager said that residents are supported to self-administer their medication and records and risk assessments for these individuals are kept. This was confirmed by some of the service users we spoke to. One person said that he had recently been supplied with a larger lockable cupboard to enable him to store his medications safely. We saw that Medications for people who need support from staff are stored securely and appropriately at the service. There is a new monitored dosage system in place, which staff said was working well, particularly as it enabled them to identify each tablet, explain what it was for and to identify any possible side effects. We checked administration sheets for three people. These had all been completed accurately. The AQAA says that no errors have been made in controlled medicines. Staff were able to say however what they would do if such an error occurred and generally demonstrated a good understanding of medication processes. The AQAA says Every resident is treated with privacy, dignity and respect at all times. These values underpin all of the care that occurs within the home We observed that everyone treated each other with courtesy and respect. Residents we spoke with confirmed that staff always knocked at their doors before entering and any assistance needed by people, for example, help with eating is carried out discretely by staff. Care Homes for Older People Page 13 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are able to make choices about their lifestyle. Activities provided are tailored to meet individuals expectations. Evidence: The AQAA says Bethany is a Christian home and its running is based on Christian principles. As such equality and diversity is incorporated into our whole ethos all people are treated without discrimination or predudice....The whole arrangement of daily life at Bethany is organised to meet our residents expectations with an inbuilt flexibility to enable a variety of diverse wishes to be accommodated. We spoke with residents who confirmed that they are supported to maintain their interests and preferred lifestyles as much as possible. There is a daily devotional service before lunch with visiting speakers. One person who has an interest and great knowledge of horticulture continues to propagate plants and from time to time presents slides on the subject to others in the home. People with different interests also give talks to share their knowldge with others. Some people continue to participate in household tasks such as dusting and flower arranging. As a response to peoples requests there is a weekly minibus service to a local Care Homes for Older People Page 14 of 25 Evidence: supermarket. Residents also told us of visits out to, for example, National Trust properties. Residents were observed to make good use of the communal grounds some with the support of the activities co ordinator where this was needed. Staff said that on sunny days, morning drinks are often served on the patio. Residents all said that their relatives and friends are made very welcome at Bethany. One person described how two visitors had recently come at short notice and the chef accommodated them so they could stay for lunch. People we spoke with have access to their personal records. People are able to bring important personal possessions with them (in consultation with management) for example one person has their cat and one is arranging for some excercise equipment to be delivered. Residents we spoke to liked the food. One person described it as excellent and said that the choice has improved recently. This is a result of a survey which was carried out regarding menus. The outcomes for the survey were positive but as a result, menus have changed to contain the most popular choices more often ,for example as roast dinners proved very popular these now appear as one of the choices 5 days a week. Residents have all been given a copy of the trial menu. We spoke with catering staff who showed a good knowledge of peoples needs and preferences and described how they could prepare special diets if these are required for health or other reasons. We spent one mealtime with service users and observed it to be an unhurried ,relaxed occasion with staff offering appropriate support where needed. Care Homes for Older People Page 15 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. Residents are able to raise issues on a day to day basis and are aware of the complaints procedure. They are also offered protection through an adult protection policy and procedure. Evidence: People we spoke with felt confident that any concerns that they may have would be listened and responded to by staff. Staff said that they knew what to do if someone expressed concerns to them and confirmed that they receive training in adult protection. The home has a clear complaints procedure which is on display and available to service users in the service user guide. The AQAA shows that two complaints have been recorded at the service in the last twelve months. We checked the complaints log during our visit and found that these had been responded to in a timely way, in line with the homes complaints procedure. Relatives surveyed were happy with the services response to comments made, eleven described this as excellent and 3 described this as good. The AQAA reflects that no adult protection alerts have been made in the past twelve months. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a spacious, well decorated, clean, comfortable and well maintained environment. Evidence: Bethany is a purpose-built care home. The home is built on three levels; each level has a different colour scheme to assist residents orientation This is particularly helpful for new residents, and for those with short-term memory loss. All three levels are fully accessible by wheelchair and there are appropriate grab rails in the public areas and individual bedrooms as required. There are several communal spaces which are all decorated and maintained to a high standard and available for use by all residents. In addition, large, beautifully landscaped gardens are there for the residents to access and enjoy. The gardens contain a pond and an aviary. The accessibility of all areas was discussed at a visit to the home in July. This was as a result of a request from the service to vary their registration to enable them to admit people with dementia. The Registered Manager was fully aware of the potential risks and stated that they will not admit a person who needs to wander. If a person develops this behaviour over time then the environment would be assessed for potential risks to that person or to others and those risks would be minimised as far as possible. Care Homes for Older People Page 17 of 25 Evidence: Two residents we spoke with said the home was like a 5 star hotel another described the atmosphere as warm and welcoming. We were shown around the home by one service user who spoke enthusiastically about the environment and the improvements that were being made, for example, an outside area is being landscaped which will improve the view from some of the bedrooms and provide an extra sitting area for residents. The home was very clean and tidy and well maintained. Thirteen Relatives surveyed rated the cleanliness of the home as excellent and one described it as good They also rated the decor and ambiance of the home very highly. We saw a certificate to show that The Environmental Health Department has awarded an excellent rating for food hygiene this year. Laundry facilities are cited away from any areas where food is kept or prepared. The laundry was well organised and clean at the time of our visit. A new system for managing peoples laundry has been started in response to peoples comments in surveys. The service has recently also employed a dedicated laundry assistant. There are procedures in place for the control of infection which include the safe handling and disposal of clinical waste, provision of protective clothing and for hand washing. We saw that these are being followed, for example, liquid soap and paper towels were available in communal handwashing areas. The AQAA says that 30 staff are trained in infection control and records that we checked showed that staff are trained routinely in this area. Care Homes for Older People Page 18 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. Service users are supported by well trained , properly recruited staff who are employed in sufficient numbers to meet peoples collective need Evidence: The rota shows that there are generally four care staff on an early shift, three on duty from 2pm - 5pm and four from 5pm to 9pm. There are two waking staff on night shift. The manager said there was also a third staff member sleeping on the premises when the number of residents reached thirty. The AQAA says that The nucleus of this staff complement is a small team of loyal, highly skilled, very reliable and experienced senior staff, 80 are qualified to NVQ Level 3 in Care and the remaining 20 qualified to NVQ Level 2 in Care. Most of these senior staff work approximately 30 hours per week and so there is generally at least one on each day shift. The majority of night team leader shifts are covered by those qualified to NVQ Level 3. This means that there is always a highly skilled, qualified individual responsible on each shift. Residents we spoke to said that staff generally responded to them quickly when they rang to ask for assistance. Staff we asked said that they mainly had time to complete the tasks they need to. Residents described staff as very good or excellent and relatives agreed, all rating the friendliness of staff as excellent Care Homes for Older People Page 19 of 25 Evidence: Specialist domestic staff are employed for meal preparation ,cleaning and laundry. Residents spoke highly of them as well, for example one resident who was out for the morning came back to find their room , including windows, thoroughly cleaned. This was done at the time that was least intrusive to them. At previous inspections we have always found that the service has adopted thorough recruitment procedures. We checked one recruitment record during our visit of one recently recruited staff member to establish that this was still the case. The recods contained all documents necessary , including for example, evidence of completed CRB check, two satisfactory references, evidence of identity and a job description. Residents we asked said that they felt confident that the staff have the skills and experience to support them safely. Staff said that there was plenty of training. Records we checked showed that staff are offered a range of training in, for example, infection control, moving and handling, dementia awareness and first aid. The manager discussed the importance of good quality training and described how the service sourced this for the staff team. The AQAA says that all permanent care staff undertake at least 21 hours of training per year. Records that we saw show that new staff are given a thorough induction programme which also includes a number of shifts shadowing more experienced members of staff. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and the administration of the home is based on openness and respect and the service has effective quality assurance systems in place. Evidence: The registered manager has now been in post for almost three years. She has Business Skills in Care Training and has recently completed the Registered Managers Award. The manager said that she attends conferences and meetings to keep abreast of current events and demonstrated a very thorough understanding of her role and responsibilities . Staff described the manager as very supportive and one person who lives at the home said she was top notch. The manager is supported by the Trustees who attend residents meetings. One trustee described how they are involved and committed to driving improvements within the home. The service has a number of systems in place to monitor the quality of of care and support provided. The AQAA says Decisions regarding all aspects of the running of the home are taken after consideration of all information collated from feedback from Care Homes for Older People Page 21 of 25 Evidence: resident and staff meetings,the quality assurance scheme, service user surveys and questionnaires sent to relatives. We saw evidence that relatives had been surveyed in 2009 and had been informed of the outcomes in a letter in August 2009. People rated all aspects of the service very highly. Residents have recently completed menu surveys and staff have completed an anonymous questionnaire giving their views about the service. People we spoke to said that their views are listened to and their suggestions are taken up and we saw evidence of this, for example, in a change to the laundry system and in a new menu. The AQAA contained excellent information and we found it accurately reflected other evidence we gathered. The AQAA says Residents are encouraged to keep control of their finances as long as possible. People we spoke with confirmed this. The service does keep small amounts of money when this is necessary and we saw that this was securely stored, individually accounted for with receipts kept where necessary. The AQAA shows that all policies and procedures have been updated where necessary and confirms that all equipment is serviced regularly. On the day we visited the homes electrical circuits were being tested. Care Homes for Older People Page 22 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 23 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 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 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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. 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