Care Home: Eton Park

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What the care home does well People`s needs are assessed in detail before they move into the home so that they can be assured that the home can meet their needs. We found detail of North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 food and television preferences, some social history as well as needs relating to medical conditions, including mental health, nutrition, continence, risks of falling and medication. The assessments of needs and risks provided a great deal of information for care to be planned and the plans we saw gave clear direction to staff about how needs should be met. People have opportunities to take part in appropriate activities within the home such as: games, cooking, poetry and aromatherapy. People told us they liked their meals and comments included, "I can choose what I want to eat." "They always give me enough to eat". The manager had carried out her own survey to find out if people were satisfied with meals. Relatives told us they knew to speak to the nurse on duty or the manager if they had any concerns and we found that complaints were dealt with efficiently. Staff had received training about Safeguarding adults. Staff are well trained and sufficient in number to meet the needs of current people living in the home. Overall the home is well run in the interests of people living there. Surveys are carried out with people in the home and separately with relatives and reports are given of the results and the action taken. What has improved since the last inspection? Since the previous inspection nursing staff have been undertaking regular audits to ensure good practice so that everyone receives their medication as prescribed. Mealtimes have been reviewed so that assistance is given to people individually as needed and meal menus have been adjusted. Staff have received more training and have worked together as a team with good communication. Improvements in the decoration and furnishing of the home were in progress during this inspection. What the care home could do better: North View Care HomeDS0000060190.V375650.R01.S.doc Version 5.2 The manager must ensure nurses do not administer eye drops at the dining table during mealtimes. This is primarily to prevent contamination of food, but also to allow people to finish there meals in comfort. In order to improve good practice we recommend clear menus be provided for people with photographs, where possible, of the meals being served. Two written references must be received in respect of any new staff before they commence work at the home. This is to ensure the protection of people living in the home. Key inspection report CARE HOMES FOR OLDER PEOPLE North View Care Home Owthorpe Road Cotgrave Nottingham NG12 3PU Lead Inspector Meryl Bailey Key Unannounced Inspection 29th April 2009 10:00 DS0000060190.V375650.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 2 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 North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service North View Care Home Address Owthorpe Road Cotgrave Nottingham NG12 3PU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 989 9545 0115 989 9311 Mr David Hetherington Messenger Care Home with Nursing 82 Category(ies) of Dementia (50), Old age, not falling within any registration, with number other category (76), Physical disability (4), of places Terminally ill (2) North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 82 (OP) That include 4 (PD), 2 (TI) & 50 (DE 55 years & Over) Date of last inspection 18th June 2008 Brief Description of the Service: North View (More recently known as Eton Park Care Centre) is a large purpose built home on the outskirts of the village of Cotgrave, five miles to the south of the city of Nottingham. The home provides accommodation, personal care and nursing for up to eighty-two people. There are mostly single bedrooms and some have en-suite facilities. Changes in the structure are in process and the overall number of rooms and division into units is changing. An up to date guide to the services will provide more information about the premises. All areas have level access making the premises fully accessible by wheelchair users. There are no amenities within walking distance of the home, which is situated at the top of a hill, not far from the A46. In the village there is a library, health centre, shopping precinct, restaurants and café, churches and a leisure centre plus other sporting facilities. Current fees range from £330 to £385 per week. This is dependent on the level of care required. An additional £10 per week is charged where ensuite facilities are provided. Copies of inspection reports are available to residents and other stakeholders upon request. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. During the inspection visit we were informed of the intention to change the name of the home to Eton Park Care Centre and this has since been confirmed. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people and their views on the service provided. This process considers the providers capacity to meet regulatory requirements and minimum standards of practice and it focuses on aspects of service provision that need further development. We reviewed all of the information we have received about the home since the last report of our key inspection in June 2008. We used questionnaires to allow relatives and staff to make comments anonymously. We did the inspection visit with one inspector. It was unannounced and took place on two days during the daytime. One method of inspection we used is called case tracking which involves us choosing a sample of people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We looked at five peoples records. Because people with Dementia are not always able to tell us about their experiences, we took extra time to use a formal way to observe people in this inspection to help us understand. We call this a Short Observational Framework for inspection (SOFI). This involved us observing five people who live in the home for up to two hours and recording their experiences at regular intervals. This included their state of well being, how they interacted with staff members and other people present and the affect of the environment. A partial tour of the premises included mainly communal areas in use and bathrooms. We also looked at recruitment records to find out if checks were carried out before new staff started working at the home and other records to see if staff were appropriately supervised and supported. What the service does well: People’s needs are assessed in detail before they move into the home so that they can be assured that the home can meet their needs. We found detail of North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 6 food and television preferences, some social history as well as needs relating to medical conditions, including mental health, nutrition, continence, risks of falling and medication. The assessments of needs and risks provided a great deal of information for care to be planned and the plans we saw gave clear direction to staff about how needs should be met. People have opportunities to take part in appropriate activities within the home such as: games, cooking, poetry and aromatherapy. People told us they liked their meals and comments included, “I can choose what I want to eat.” “They always give me enough to eat”. The manager had carried out her own survey to find out if people were satisfied with meals. Relatives told us they knew to speak to the nurse on duty or the manager if they had any concerns and we found that complaints were dealt with efficiently. Staff had received training about Safeguarding adults. Staff are well trained and sufficient in number to meet the needs of current people living in the home. Overall the home is well run in the interests of people living there. Surveys are carried out with people in the home and separately with relatives and reports are given of the results and the action taken. What has improved since the last inspection? What they could do better: North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 7 The manager must ensure nurses do not administer eye drops at the dining table during mealtimes. This is primarily to prevent contamination of food, but also to allow people to finish there meals in comfort. In order to improve good practice we recommend clear menus be provided for people with photographs, where possible, of the meals being served. Two written references must be received in respect of any new staff before they commence work at the home. This is to ensure the protection of people living in the home. 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. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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’s needs are appropriately assessed before they move into the home so that they can be assured that the home can meet their needs. EVIDENCE: We looked at the files of five people that live at the home. All of these contained assessments carried out prior to moving in. The acting manager told us that she visits people wherever they are prior to them moving to the home in order to assess their needs. The assessment of a person who moved into the home recently was very detailed giving information about food and television preferences, some social history as well as needs relating to medical conditions, including mental health, nutrition, continence, risks of falling and medication. The assessment procedure clarified that needs could be met within this care home. Two relatives that we spoke with confirmed that they had been involved in an assessment procedure. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs are appropriately met. People are treated with respect and staff take positive action to uphold people’s privacy and dignity. EVIDENCE: The assessments of needs and risks provided a great deal of information for care to be planned and the plans gave clear direction to staff about how needs should be met. Staff were directed about what assistance people needed to move. During our observations we saw that the hoist was used with some people and others were assisted with a belt into a wheelchair or encouraged to use a walking frame. The plans detailed whether one or two care assistants were needed. Care plans had been regularly reviewed and updated to meet changing needs. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 11 Staff told us they checked the care plans and were also given updated information by the nurse on duty. Since the previous inspection nursing staff have been undertaking regular audits to ensure good practice in administering medication. We saw forms for this that have been completed each month. The acting manager also gave us a copy of the updated policy, which included the use of homely remedies and arrangements for people who are able to manage their own medication. We observed a nurse administering medication. She followed correct procedures and we saw that everyone received their medication as prescribed. One person, though, required eye drops and these were instilled during lunch, which was not appropriate and the person did not continue with eating afterwards. We discussed this with the nurse and also with the manager and both agreed that eye drops would be given after lunch in future. During our observational period we saw that some people were at rest during the late morning. Staff spoke respectfully with people and one of the staff who was visiting, but off duty, interacted very positively with one person, who became very alert and happy to have the attention for a short time. She continued to be alert, but other staff were busy with personal care tasks and their interactions were short. On two occasions we saw staff moving people from sitting chair to wheelchair without speaking to them, but at all other times we observed positive comments, with directions and explanations given. When using the hoist staff were careful to cover people so that they retained their dignity. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 have opportunities to take part in appropriate activities and are satisfied with the meals provided. EVIDENCE: In the care plan files we saw people’s interests and social history information had been written down. There was a file in the lounge area containing suggested activities and records of activities that had taken place. There was a calendar of events which included cooking every Tuesday morning, Beauty Club on Tuesday afternoons, Poetry Club on Wednesday afternoons, Aromatherapy on Thursday mornings and Games on Thursday afternoons. We spoke with the visiting aromatherapist and some people told us they enjoyed individual sessions. During the morning people were receiving help with personal care and getting ready for lunch. During the afternoon, people were singing along to music and some staff made attempts to engage people in games. The acting manager told us that a new Activities Coordinator had been appointed and was due to start in the following week. Relatives visited North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 13 throughout the day and those we spoke with told us they always felt welcome. There was a notice about Church services that were held on the first Thursday every month. During the second day of our visit people were looking forward to the evening when a party was planned for one person who was celebrating 100th birthday. We observed part of lunch time on both days and the meal was taken in two sittings. Staff assisted some people with eating and were seated next to them at the table, though one person had to wait for ten minutes until a staff member was available to help. A choice of meal was given and served to meet individual needs. Some people had their meal blended and each food was blended separately to distinguish colour and taste. People told us they liked their meals and comments included, “I can choose what I want to eat.” The menus showed a range of nutritious and balanced meals available. The menu for the day was on a board, but some people said they could not read what was written there and staff told them what meals were available. The results of a recent survey carried out within the home showed that the majority of people judged the food to be good or very good. One relative told us the food was not so good sometimes, but another said improvements had been made in this area. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 listened to and safeguarded from abuse. EVIDENCE: The Complaints Procedure was displayed on a notice board and included within the Service User Guide. Relatives told us they knew to speak to the nurse on duty or the manager if they had any concerns. The acting manager gave us evidence of responses made to complaints that had been raised and appropriate actions had been taken immediately. Some people expressed concern about the building work and temporary changes made. However, the acting manager had explained to everyone what was being done and how the work will enable improvements to be made for everyone. Staff told us they had received training about Safeguarding adults and there were records to confirm this. The acting manager had followed the local procedures for safeguarding adults when required. We saw the outcome of one investigation carried out by a social worker. Action had been taken to increase staffing resources as a result of this. We saw evidence that new staff had been checked through the Criminal Records Bureau before starting work at the home. However, some written references had not all been received (see staffing section). North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People temporarily experience an unsettling time whilst building work is being completed, but all areas are kept as clean and comfortable as possible. EVIDENCE: Major building work was ongoing during this inspection visit. The two units of the home were being converted into three units and all areas were also being refurbished. Most people were accommodated in what was previously the lower unit. All areas there were clean, with the exception of the floor of the clinic room. This floor was replaced a week after this inspection. Within the lower unit there were plans to change the dining and lounge areas to create more space. The laundry had sufficient machines to meet people’s needs. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 receive care from trained nurses and care staff, though systems for recruitment do not fully ensure the integrity of new staff is supported by references. EVIDENCE: The rota showed there were six care staff for the greater part of the day and one nurse to meet the needs of 43 people. No one was currently looked after in bed though there were some that needed two staff to assist them when moving. Relatives told us that there always seemed to be enough staff to assist people. Staff themselves told us they had enough support from each other and worked as a team. The acting manager said that there was no set formula for working out the number of staff needed, but when there were more people with higher needs she arranged for more staff to be on duty. There were plans to admit people with higher needs in part of the home and staffing would be according to the assessed needs. Most of the current people were in one area for the greater part of the day. There were three people in another area of the building and we saw that one care assistant was dedicated to their care at all times. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 17 Staff told us they were given a lot of training and records showed that more than 50 care staff had attained a National Vocational Qualification (NVQ) at least level 2 in Care. Other staff had enrolled on a course and some had moved on to higher levels. One of the nurses was a qualified assessor for NVQs. All health and safety training was provided at regular intervals and nurses and care staff had been trained in Dementia, management of violence and aggression, and effective communication. A sample of four staffing records confirmed that new staff had been checked through the Criminal Records Bureau before starting work at the home. However, for two of these staff full written references had not all been obtained. The acting manager stated that it was sometimes difficult to get references, but she would pursue these. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run, with systems in place that ensure the interests of people living in the home are a priority. EVIDENCE: The same acting manager has continued at the home for the last two years. She made an application to the Commission for registration, but some documents were missing and this process has taken longer than is usual. She has, though, cooperated with the Commission in responding to all letters about registration and intends to complete the process as soon as possible. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 19 The acting manager provided reports and graphs completed from the results of surveys that have been carried out. Relatives had received a report of the 2008 survey. The Annual Quality Assurance Assessment (AQAA) form was completed and submitted to the Commission by the acting manager at the beginning of April 2009 and provided us with all the information we asked for. Most people’s cash was looked after at the home and was held securely with clear records and receipts. We checked amounts held for two people and found records were accurate. Each entry was signed and witnessed. There was a clear matrix chart to confirm the health and safety training given to staff in Moving and Handling, First Aid, Food Hygiene and Infection Control. It showed that training was up to date and gave clear indication of when the next refresher training was needed. The AQAA form gave us details of servicing of equipment and the acting manager informed us that a new call system was being fitted. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement Eye drops must not be administered at the dining table during mealtimes. This is primarily to prevent contamination of food. Two written references must be received in respect of any new staff before they commence work at the home. This is to ensure the protection of people living in the home. Timescale for action 31/08/09 2. OP29 19 31/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations Provide clear menus for people with photographs of what meals are being served. North View Care Home DS0000060190.V375650.R01.S.doc Version 5.2 Page 22 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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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