Care Home: Eden Court Nursing Home

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What the care home does well People`s needs are assessed prior to them moving into the home and are able to visit the home to establish whether or not it is the right place for them. Staff were observed being friendly, polite with cheeful dialogue between themselves and people using the service. Comments from people living at the home, regarding the staff and care they receive include: "I find the service good in all areas." "Friendly staff." "They care for us." "The service has improved recently." "A very good home, clean, staff are caring." People living at the home can be confident that their complaints will be listened to, taken seriously and acted upon. Staff and people spoke highly of the deputy manager and said she is always available and very approachable. People said "Things are much better since she came." What has improved since the last inspection? All staff have had movement and handling training to make sure they are aware of current practice and therefore reduce the risk of injury to themselves or people in their care. All staff have had fire training and drills to ensure that they know the procedure to follow in the event of a fire. The activities person has a programme of activities so that people know what activities are on offer each day. What the care home could do better: The handwriting in care records should be legible as it is essential to the provision of safe and effective care. All staff should record when they carry out an activity with a person to show evidence that their social needs have been met. There should be a clear audit trail of complaints received to show that the process has been properly followed. 50% of staff are recommended to have an NVQ 2 qualification in care, as qualified staff have a better understanding of peoples needs. Key inspection report Care homes for older people Name: Address: Eden Court Nursing Home Ghyllroyd Drive Birkenshaw Bradford West Yorkshire BD11 2ES     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: Karen Summers     Date: 1 9 0 1 2 0 1 0 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 28 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 28 Information about the care home Name of care home: Address: Eden Court Nursing Home Ghyllroyd Drive Birkenshaw Bradford West Yorkshire BD11 2ES 01274652002 01274689054 eden.court@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Speciality Care (UK Lease Homes) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 45 The registered person may provide the following category of service only: Care Home with Nursing, Code N. 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, Code OP, maximum number of places 45. Physical disability, Code PD, maximum number of places 45. Date of last inspection Brief description of the care home Eden Court provides care, nursing and accommodation for up to forty-five people. The home is purpose built. It has thirty-seven single rooms, four double Care Homes for Older People Page 4 of 28 Over 65 45 0 0 45 1 1 0 3 2 0 0 9 Brief description of the care home rooms and ten of these bedrooms have en-suite facilities. There is a large lounge, one quiet lounge, a small smoking lounge and a quiet sitting area on the upstairs landing. There is a large garden at the home, where residents are able to sit in the better weather. The home is situated within close proximity of the A58 Leeds Road, with access to public transport links and local shops. Ample car parking is available at the home. The Care Quality Commission (CQC) were informed on the 19th January 2010 that the fees range from £350.00 to £650.00 per week. Information about what the service provides can be seen in the service user guide and is available at the home together with the last inspection report. Care Homes for Older People Page 5 of 28 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 report refers to an inspection, which included an unannounced visit by one inspector on the 19th January 2010, and the length of the inspection was approximately 8 hours. The home is presently advertising for a manager and until one is appointed the deputy manager is in charge of the home with support from senior management within the company. The deputy Manager and Business Service Manager were present on the day of the inspection. Date of the last inspection of this service was 11th March 2009. The purpose of this inspection was to look at how the needs of people living in the home are being met and we focused on the outcomes of the key standards. Care Homes for Older People Page 6 of 28 During the visit we spoke to people living in the home, visitors, staff and management. We looked at various records including peoples care plans and staff files. We looked around some of the building and we observed staff while they carried out their duties. As part of the inspection in order to provide information to help us form judgments about the quality of the service, the manager was asked to complete an annual quality assessment (AQAA) document. This she did, and the document provided the Care Quality Commission (CQC) with a lot of information about the way the home is run, and what they hope to achieve in the future. To enable people who use the service to comment on the care it provides, we sent ten surveys to people living at the home and ten to staff, all of which were returned. Ten to relatives/ advocates, six of which were returned, and five to health care professionals, three of which were returned. Comments from these surveys have been included in this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 28 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 Care Homes for Older People Page 8 of 28 order line 0870 240 7535. Care Homes for Older People Page 9 of 28 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 10 of 28 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 are assessed prior to them moving into the home to ensure that their needs can be met. Evidence: The care records of three people who use the service were looked at, and they contained a Community Care Assessment carried out by the local authority who fund the placements. Each assessment contained detailed information about the persons needs. In addition to this there was evidence in all of the records that the home had also carried out an assessment of the persons current needs in their place of residence. The information in the annual quality assessment document confirmed that all prospective people undergo a pre-admission assessment to ensure the staff are qualified and skilled to meet the needs of the person and the placement will be appropriate. Care Homes for Older People Page 11 of 28 Evidence: Prospective people who use the service and their families are also encouraged to visit the home and spend some time there meeting the staff, other people living at the home and sample the daily routine. This is to gain an insight of how they view the service. The manager also said that people are made aware of the advocacy services should they need guidance and assistance regarding their specific circumstances, and leaflets were seen to be available in the entrance of the home. Seven out of ten people who completed the surveys said that they received enough information about the home before they moved in so they could decide if it was the right place for them. Three people said that they did not know if they had received enough information as their relatives had chosen the home for them. Care Homes for Older People Page 12 of 28 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. Peoples care needs are met however this could be compromised by inadequate record keeping of which the deputy manager is taking steps to address. Evidence: Three peoples care plans were looked at, and the records included relevant risk assessments relating to falls, pressure care and nutrition etc. The documentation also included peoples likes and dislikes, their social, cultural and spiritual needs. There was information in the care records of involvement from peoples doctors, social workers, opticians and other health care professionals where needed. Care reviews had taken place, and the care plans had been updated monthly or as the needs of the person changed, and this was with the involvement of the person or their relative wherever possible. However, we discussed with the managers that depending on who had written the care records, some of the information was illegible. The handwriting in care records Care Homes for Older People Page 13 of 28 Evidence: should be legible as it is essential to the provision of safe and effective care. The nurses should refer to the Nursing and Midwifery Guidance on the Principles of good record keeping. The deputy manager said that she would take steps to address the situation. We also discussed, that where movement and handling slings are need for an individual, then the size of the sling to be used should be recorded, and people should have their own sling to reduce the risk of cross infection. This had been identified at the previous inspection, and the deputy who has recently come into post said that she is in the process of looking into providing individual slings for those people who need them. Staff said that they now record the size of the sling to be used and there was evidence of this in the records inspected. The hairdresser was visiting on the day of the inspection and one person was seen to only have one foot rest in use. The maintenance person said that within his routine health and safety checks he had identified that staff are on occasions removing foot rests from the wheel chairs and therefore was in progress of making sure that the footrests could not be removed from the chairs. Evidence of this was demonstrated on the day. Nine out of ten people who use the service said that they receive the care and support that they need and one person said that they sometimes did. Without exception everyone said that staff were always/ usually available when they need them and listen and act on what they say. Six relatives returned surveys and all of them said that the care service meets the needs of their relative and that the service gives the support and care to their relative that was agreed. Comments include: I find the service very good in all areas. They care for my mother. Friendly staff. Eden Court keeps me informed if there are any problems. Comments from social and health care professionals (doctors, pharmacist, podiatrist, social workers etc.) include: Respect individuality. Respect peoples rights. Offers help/support to provide best possible for residents. Calls us to visit appropriately. Involved in Gold Standards Framework - End of life care. A sample of three peoples medication records were checked, and the storage, administration and recording of the medication were done correctly. Care Homes for Older People Page 14 of 28 Evidence: There were several occasions when the drugs refrigerator temperature was recorded as been higher than it should have been. We advised that the temperature be taken in the morning before the refrigerator is opened as this would give a more accurate reading. Care Homes for Older People Page 15 of 28 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. People living at the home are offered a range of activities and are able to make their own choices about how they spend their time. Evidence: On the morning of the visit people were seen to be having tea and sat in the lounge areas or their rooms, watching television or talking to one another. Staff were seen to be interacting with people in a friendly and caring manner and the movement and handling of people using the hoist was carried out in a dignified way. The activities timetable was displayed in the entrance of the home and the activities person said that she usually visits people and asks them if they would like to take part in the activity she is doing that day. The activities person also said that she presently works Monday to Friday, 9am until 3pm, however due to a number of people choosing not to get up until later in the morning, she often becomes involved in care duties and does not spend as much time on activities. This has been discussed at residents meetings and with the deputy manager and it has been agreed that the activities person will start at 10am until 4pm Care Homes for Older People Page 16 of 28 Evidence: and this will be purely as a dedicated activities coordinator. The activities records of three people were looked at and when the activities coordinator is on duty she records their involvement and enjoyment of the activity however, the activities person is not able to visit everyone on a daily basis and when staff have done an activity it has not been recorded. This was discussed with the deputy manager and she said that she would ensure that this was addressed. Comments from staff about what the home could do better in relation to activities include, I feel the residents dont have as much opportunity to become involved in activities as they could. This is mostly due to lack of enthusiasm or incentive of staff, however the is possible evidence that this is already in the process of being amended as there are extra hours being offered to the role of activities coordinator. The activities person was enthusiastic about her role in providing the right activities for everyone. Without exception people who completed the surveys said that they were always activities that they could take part in. Comments include, Activities are fantastic. There was a choice at meal time and specialized diets are catered for. The care staff said that the cook and carers ask people on a daily basis their food preferences for the next day and people who use the service confirmed this. Care Homes for Older People Page 17 of 28 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. People can be confident that their complaints will be listened to and acted upon. Evidence: With the exception of one person people living in the home and their relatives said that they knew who to speak to if they were not happy and everyone knew how to make a complaint. CQC have not received any complaint since the last inspection. Records showed that the home has received one complaint and the AQAA states that it was addressed within the 28days timescale however; the documentation relating to the outcome of the correspondence was not seen. This complaint related to an incident prior to the new deputies appointment, and she said that she would in future ensure all correspondence was recorded and record kept. Comments received in surveys from people living in the home include: Dont think theres anything they could do better. I feel I can speak to the staff. The home has a complaints procedure of which a copy was seen in the entrance of the home, together with the Whistle Blowing procedure. Staff and the deputy manager showed knowledge of the complaints and whistle blowing procedures. Care Homes for Older People Page 18 of 28 Evidence: There was evidence in the training records to suggest that staff have had safeguarding (adult protection) training that provides information on how to protect people from abuse, and staff who were spoken with confirmed this. Care Homes for Older People Page 19 of 28 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. The home continues to be decorated to a good standard and offers people a homely, comfortable and clean environment. Evidence: As part of the inspection a tour of the home took place, which included the communal areas and a number of bedrooms. At the time of the visit the entrance and stair case was in the process of redecoration, and there was evidence to suggest that ongoing refurbishment continues to take place. Specialised equipment and specialised mattresses and beds were also seen to be in use. When asked what could the service do better, comments from health care professionals include, Treatment room small, cramped, sometimes interrupted when seeing patients. The deputy manager said that she was looking into where they could have a room to use as a dedicated treatment room and where people would not be interrupted when being seen by a doctor. The standard of cleanliness throughout the home was good, and systems are in place to control the spread of infection. Without exception, people said in the surveys that the home is always fresh and clean. Care Homes for Older People Page 20 of 28 Evidence: When asked what does the service do well, comments from relatives include, Cleanliness - of the residents, their rooms and public areas. Care Homes for Older People Page 21 of 28 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. People are supported and protected by the homes recruitment practices. Evidence: On the day of the visit there were forty three people in residence. The duty rota was looked at. The manager confirmed and there was evidence to suggest that there were two nurses and six/ eight staff employed throughout the day and the deputy manager was supernumerary Monday - Friday. And there was one nurse and three carers employed at night. Support staff are also employed to meet the needs of the home and these include: kitchen staff, laundry staff, domestics, activities coordinator, maintenance person and gardener. The duty rota showed that there were enough staff to care for people properly and this was confirmed by the manager. When asked what could the service do better, comments from relatives include, Needs more experienced carers on duty to deal with residents increasing needs as they get older. Needs more mental stimulation, activities for residents. Care practice observed during this visit, and the relationship between staff and people being cared for was positive. Care Homes for Older People Page 22 of 28 Evidence: Three peoples recruitment records were inspected and with the records contained the required information and employment checks. These checks are necessary to help protect people from potentially unsuitable staff. There was evidence in the staff records and staff confirmed that they had induction training when they came to work at the home, which provides them with the knowledge and skill to look after people in their care. According to the training records, all staff have up to date movement and handling training to ensure that they know how to move people safely and this was confirmed by the staff that were spoken with. Further training sessions have also been booked for February 2010. Staff also have Dementia training to ensure that they have the knowledge and skill to care for people who have this disability and records were seen to confirm this. Forty two percent of care staff have a level 2, National Vocational Qualification in Care (NVQ) in care, and a further five staff are doing the qualification. 50 of staff are recommended to have the qualifications, as qualified staff have a better understanding of peoples needs. Care Homes for Older People Page 23 of 28 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. People benefit from the management approach of the home, and the home is run in the best interests of people who live there. Evidence: The home is presently advertising for a manager and until one is appointed the deputy manager is in charge of the home with support from senior management within the company. Staff and people spoke positively about the deputy manager and said she is very approachable. A relative made the comment, Eden Court has been without a full time manager and deputy for months. Relatives have not been kept regularly up to date with the managerial staffing situation. As part of the inspection in order to provide information to help us form judgments Care Homes for Older People Page 24 of 28 Evidence: about the quality of the service, the manager was asked to complete an annual quality assessment (AQAA) document. This she did, and the document provided the Care Quality Commission (CQC) with a lot of information about the way the home is run, and what they hope to achieve in the future. The managers said that an annual quality monitoring survey is sent out to people who live at the home and their relatives each year and that the outcome of this years survey will be discussed at the next residents/ relatives meeting in the next two weeks. There was evidence that staff supervisions have now commenced and staff confirmed this. Staff are supervised to ensure they are competent to do their job. The AQAA states that routine health and safety and maintenance checks are carried out and appropriate records were seen of those looked at. Records were also seen of fire alarm and emergency lighting tests. Fire drills and a fire lecture had also been carried out and the maintenance person confirmed that he gave regular fire lectures and drills to the staff and this included the night staff. This was also confirmed by the staff on the day of our visit. A hand book was seen that is given to staff about the Mental Capacity Act, and the deputy manager said that she had received training on Depravation of Liberty which she intended to include in the staff training and then into the care documentation of people who use the service. This is to ensure that staff are aware and up to date with current guidance and that people are protected from abuse. Care Homes for Older People Page 25 of 28 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 26 of 28 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 7 The handwriting in care records should be legible as it is essential to the provision of safe and effective care. The nurses should refer to the Nursing and Midwifery Guidance on the Principles of good record keeping. All staff should record when they carry out an activity with a person to show evidence that their social needs have been met. There should be a clear audit trail of complaints received to show that the process has been properly followed. 50 of staff are recommended to have an NVQ 2 qualification in care, as qualified staff have a better understanding of peoples needs. 2 12 3 16 4 28 Care Homes for Older People Page 27 of 28 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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