Care Home: Clinton Care

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What the care home does well Staff enable people to make choices and treat them with respect. The house is clean and homely and people are able to personalise their rooms. The home is well managed and the people we talked to, told us that they were happy at the home and thought that staff treated them well. What has improved since the last inspection? A new manager has been appointed who has worked in the home for some time and knows the people living there well. She has worked hard to improve the care plan system and they are now comprehensive and cover all aspects of people`s life. The work on the care plans included reviewing risk assessments. The provision of activities has been increased with special one off outings being planned and daily activities being arranged for people who want to go out. All the three requirements made during the previous inspection have been complied with. There has been a program of redecoration and improvement in the home. The main lounge has been redecorated and the carpets and furniture has been replaced. The cellar has had the floor resurfaced, the walls have been plastered and painted and some of the bedrooms and bathrooms have been decorated. A new washing machine has been provided for the laundry. What the care home could do better: During the inspection we did identify several areas that needed improvement but since the visit the manager has contacted us and has told us that she has taken action to rectify them or has undertaken to carry out the work very soon. Key inspection report Care homes for adults (18-65 years) Name: Address: Clinton Care 5-9 St Michaels Avenue Northampton Northants NN1 4JQ     The quality rating for this care home is:   two star good 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: Ann Wiseman     Date: 2 4 0 2 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 Adults (18-65 years) Page 2 of 26 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Clinton Care 5-9 St Michaels Avenue Northampton Northants NN1 4JQ 01604632165 01604620619 clintoncare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ms Aileen Holland,Ms Una Holland care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: To include within the total of 17, a maximum of 10 service users in need of personal care by reason of Mental Disorder, excluding learning disability or dementia over the age of 65 years. Date of last inspection Brief description of the care home Clinton Care is situated in a residential area close to local shops, leisure facilities and other amenities. It is also close to the main bus route into Northampton town centre. The accommodation provides a service for adults with mental health needs in both single and shared rooms. There is a range of communal areas and the lounge opens out onto a garden for people to use in good weather. The home has a Statement of Purpose and a Service Users Guide, which can be obtained from the manager. The range of fees are between £340 to £400 per week. This is an all inclusive fee. 17 Over 65 10 Care Homes for Adults (18-65 years) Page 4 of 26 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection; we arrived at 9.20am in the morning and left soon after 5.30pm. The manager was on duty and facilitated the inspection, which she did in an open and helpful manner. Whatever files and documents we asked to see were quickly produced and were well ordered. During the day we had a look around the home and talked to some of the staff and some of the people who live in the home. We also had an opportunity to speak with one of the owners. We looked at information belonging to three people and the available information of three of the staff. We also assessed some of the homes policies and procedures and sampled a random selection of the health and safety files and records. Before the inspection the manager had sent us the Annual Quality Assurance Assessment (AQAA) she had completed. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some Care Homes for Adults (18-65 years) Page 5 of 26 numerical information about the service. The AQAA was sent to us within our set timescales and showed that the home recognised areas that need further improvement. The house was clean and tidy and the atmosphere was friendly and congenial, interaction between the staff and the people living in the home was observed to be friendly and open. When talking about people, staff did so in a supportive and respectful manner and written notes were also written appropriately. Care Homes for Adults (18-65 years) Page 6 of 26 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 Adults (18-65 years) Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into Clinton Care are offered enough information to enable them to make an informed choice about moving into the home, although the statement of purpose and users guide needs updating and expanding to include more information about the local area. Everyone has their care needs assessed before they move in. Evidence: The homes statement of purpose was updated in December 2007 and its content is clear and comprehensive. The residents guide was updated in June 2006 and although it carries all of the required information it would benefit from having local information included, such as what are the local amenities like and what public transport connections are there in the area. Both the documents are due to be reviewed and when they are consideration should be given to including photographs of the home, its facilities and the local amenities. The group of people living in the home has been quite stable over the years with few changes. Last year there were four new admissions and we were able to test the Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: admission process by reading peoples files and examining the information gathered when they moved in the home. We examined three peoples files during this inspection and found that they contained assessments done by the home and care plans derived from the assessment. We saw copies of the contracts that are given to people, they clearly set out the terms and conditions of the placement. The admission processes were discussed with the new Manager and we found it to be appropriate, she told us that peoples needs are fully assessed prior to admission, she reassured us that information about the home is provided and explained to people and arrangements for pre-admission visits are flexible and according to need. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have care plans and are assisted to make decisions about their life and are consulted about the way they want to live. People who live in the house are enabled, through risk assessments, to take some risks as part of an independent lifestyle. Staff are trained to respect confidences and to handle personal information in a way that will maintain confidentiality. Evidence: We examined three peoples care plans, they reflected the needs and aspirations of the person involved. The newly appointed manager has completely redesigned and updated them since the last inspection and we saw evidence that shows that they have been reviewed at regular intervals. She is still developing them and since this inspection she has told us that she has made both the care plans and the assessments more detailed. The files showed that people who live in the home are enabled to make decisions about the home and the things they do. In the AQAA the manager told us that people have been included more in the Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: production of their own care plans and we saw that people has signed them to indicate that they have read and agreed with them. The files contained risk assessments that are developed to minimise risk of harm in peoples every day activities. Staff induction training includes the importance of keeping peoples confidences. When not in use private information is stored in a locked cupboard and is not left lying around in communal areas. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities are offered in and out of the house that makes people a part of the local community. Friends and family are welcomed in the home and peoples rights and responsibilities are recognised and upheld. Food offered is varied and meals are eaten in comfortable surroundings. Evidence: People living in this home are able to make their own choices and some access the community independently. We saw evidence, in the files we looked at, that people are supported by staff to go out if they need it and those we spoke to expressed satisfaction with the activities offered to them. Entertainers are bought into the house and we were told that they are very popular and people ask for them to return when activities are discussed at house meetings. Trips are organised to the cinema, pub and other local amenities and people are given Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: the option to attend if they want to. At the moment activities are not recorded, other than in peoples daily records, and we had a discussion with the manager and owner about the best way to do this so that there will be a central record of what activities are offered, who attends them and the outcome. This will be a valuable tool for the manager to use to monitor what activities take place and what is popular. Some people work in a local charity shop, others like to use the library and have personal computers in their room. The home has a computer set up in a communal area for general use, which is connected to the Internet. We saw that peoples religious preferences are recorded on their care plans and people are supported to attend religious services if they want to. The manager assured us that families and friends are welcomed into the home and are invited when the home has a party, a BBQ or other celebration. People are helped to keep their rooms clean and tidy and are encouraged to give suggestions for meals. The menu has been reviewed since the last inspection and the home has offered a larger variety of meals since then. We looked in the food cupboards, freezers and fridges, they were well stocked with fresh, tinned and frozen food as well as snacks and treats. There is a dinning table in the kitchen where people can sit to eat and they are also given the option of eating in the sitting room if they choose. We observed a meal being served and eaten, it was a relaxed occasion and when we talked with people they said they enjoyed their meals. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home records peoples personal care needs in a way that enables them to be supported as they want to be. People have access to doctors and specialist care and medication is managed properly. Evidence: We looked at three peoples care plans and found that their support needs were clearly recorded and that they were written in a way that reflected their personal preferences and we saw that the care plans had been reviewed regularly since the last inspection. The manager has completely restyled the format and has improved the quality of the information that is collected. We discussed areas where they could be further improved and since the inspection she has told us that she has made more improvements to the care plans. We found evidence, in the files we examined, that people have access to medical practitioners as and when they need to, they also get support from specialists such as consultants, psychology, psychiatric, dentists and opticians. We examined the medication and its records and found that they were as required. There were no recording errors or omissions and the medication is stored appropriately. Care Homes for Adults (18-65 years) Page 15 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaint policies and procedures are in place and we were assured that if any were received, all complaints would be investigated. Systems are in place to properly record complaints and concerns. People are protected from abuse by staff being properly trained in safeguarding and managing challenging behaviour. Evidence: The home has complaint and safeguarding policies and the complaints procedure is displayed in the home. Since the inspection the complaints and concerns book has been changed to make sure that they are recorded in a way that makes it possible to follow them from start to finish easily. The manager told us that they havent received any complaints since the last inspection and there were none recorded in the complaints book. Nor have we received and complaints made directly to us in the last year. There are residents meetings held regularly and everyone is invited to attend and share their views about the home. A record of these meetings are available for people to refer to. One person we spoke to said, I love living in this place and have nothing to complain about. The home keeps us informed of any incidents and situations that may have an adverse Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: effect on the lives of the people who live in the home via regulation 37 notifications and the manager told us that all staff undertake safeguarding, whistle blowing and managing challenging behaviour training, we saw evidence that the training takes place on peoples personnel files. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is safe, comfortable, clean and hygienic. Bedrooms suit peoples needs and lifestyle and there are sufficient bathrooms and toilets. Evidence: Clinton Care is homely, comfortable and is clean. There is an ongoing programme of decoration to the communal areas and peoples rooms. The main lounge has undergone a makeover recently, with new furniture, carpets and redecoration. Apart from the main lounge, there are several rooms and areas in the home, which people can use if they want to sit quietly or receive visitors privately. The garden is well presented and easily accessible from the lounge. There are sufficient bathrooms and toilets to meet peoples needs and some have been fitted with equipment and aids to maximise independence. The manager has told us that since our last visit to the home the bathrooms and some of the bedrooms have also been redecorated. The home has a very large cellar which is made up of several different rooms that are used as a laundry, drying room, overflow larder and storage rooms, people living in the home should not have access to this area, the stairs are steep and concrete and Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: would be dangerous for people with poor mobility to use, care should be taken to make sure that the door to the cellar is kept locked at all times. During the inspection it was obvious that the cellar the floor was in need of work to make it safe as it was broken and some areas were potentially a trip hazard to the staff using the area. The manager has told us that, since our visit, the cellar has been completely revamped. The walls have been plastered and painted and the floor has been screened, sealed and covered. Work has been carried out to comply with a fire officers visit to the home prior to our inspection. This included new fire door and seals where needed, smoke detectors have also been added where needed. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are aware of their roles and responsibilities and are qualified. The home has recruitment policies and procedures in place that are being followed. Relevant training is given and the staff are receiving supervision. Evidence: We examined staff personnel files and found they held all the information and documents that are required. We spoke to two staff members on this occasion and they confirmed that all the checks that safeguard people are being carried out before new staff start work. As well as care staff the home employs domestic staff and a cook. The manager has told us that she has recently increased staffing numbers to improve the staffing ratio, so that the home can offer more support to the people they care for, this will allow extra one to one time and give people more opportunities to get out. We noted from the staff files that there is evidence that people get some supervision, but not as often as we would expect, the manager agreed that staff would benefit from receiving it more often, but we acknowledge that she has only recently taken up her post and has made many improvements already and we are confident that her commitment to properly supervising the staff will mean that staff get supervised Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: adequately. Regular staff meetings are held and staff are encouraged to add items to the agenda. The care staff we spoke with displayed a good knowledge of the people in the home and understood their needs. Information given to us in the Annual Quality Assurance Assessment (AQAA) completed by the manager, tells us that the home has met the minimum of 50 of its staff having attained the NVQ 2 in care or its equivalent. The staff records show evidence that the home offers the required training to its staff, a dementia course is taking place in June. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is well run and the ethos of its management is empowering to the people living in it and their views underpin its running. The policies, procedures and the record keeping protect peoples rights and best interests and health and safety is promoted and necessary checks are made and records kept. Evidence: The manager has been newly appointed since the last inspection and was working at the home as a senior carer prior to gaining the promotion. She is just about to finish her management training then, she has told us, she will apply for registration with us, when she does she will be assessed as being a fit person to care for vulnerable people. During discussions about the people living in the home she proved to be knowledgeable about their needs and abilities. She facilitated the inspection in an open and friendly manner, was open to suggestions and talked about the plans she had to improve the quality of service offered to the people in her care. She was able to find everything we asked for and had sent us the annual quality assurance assessment (AQAA) when we asked for it. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: The home sends annual surveys to staff, people in the home and their relatives. Once they are returned the information is collated and action is taken when shortcomings are highlighted. House meetings are held where people are encouraged to speak their mind about how the home is run and how it can be improved. The manager assured us that records are kept of these meetings. We are told in the AQAA that the homes polices and procedures are reviewed and updated as legislation dictates, since the inspection the manager has informed us that she has reviewed the COSHH folder as well as the policies and procedures. During the visit to the home we saw that records are kept up to date and are stored appropriately. Personal details are stored in a locked cupboard in the office and are not left unattended, staff are asked to read and sign the organisations policy on confidentiality during their induction. A sample of health and safety records was inspected and was found to be in order. The fire officer carried out a fire safety visit last year and action had been taken in the areas he singled out, some of the fire doors and seals have been repaired or replaced. Fridge and freezer temperatures are taken and recorded daily, while looking at the records of the freezer temperatures it seemed apparent that the thermometer used was not recording them properly. The thermometer was immediately replaced with a new one. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Both the residents guide and the statement of purpose are due to be reviewed and updated, although they carry all of the required information they would benefit from having local information included in them, such as what are the local amenities like and what public transport connections are available. Consideration should be given to including photographs of the home, its facilities and the local amenities as well. Care Homes for Adults (18-65 years) Page 25 of 26 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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