Care Home: Grosvenor House Nursing Home

What the care home does well The service provides information for people who are thinking of moving into the home. An assessment takes place prior to a new admission taking place to ensure that identified care needs are able to be met. Activities are available within the home. These can stimulate people living in the home. The home was well maintained, clean and tidy. Visitors were made welcome. What has improved since the last inspection? Since the previous inspection changes have taken place in relation to the activities coordinator post. A new co-ordinate is now in post who hopes to be able to develop the range of activities available. Significant improvements have taken place regarding the environment therefore providing people with a more comfortable place to live. Other improvements include the fitting of a sluicing disinfector. What the care home could do better: Written records are not always up to date in relation to care plans. Staff were knowledgeable about care needs but having missing written information could result in unsafe practices taking place. We brought to the attention of managers a need for improvement in the management and recording of medication. Immediate action took place in order to ensure the health safety and welfare of people using the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grosvenor House Nursing Home Aqueduct Lane Alvechurch Nr Birmingham West Midlands B48 7BS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrew Spearing-Brown     Date: 0 3 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Grosvenor House Nursing Home Aqueduct Lane Alvechurch Nr Birmingham West Midlands B48 7BS 01214477878 01214477823 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Alpha Care Homes Name of registered manager (if applicable) Ms Jean Tandy Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Age: Dementia (DE) age 55 and above. Physical disability (PD) age 55 and above. The maximum number of service users who can be accommodated is: 25 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: Dementia (DE) 25, Old age, not falling within any other category (OP) 25, Physical disability (PD) 25 Date of last inspection 25 0 25 Over 65 0 25 0 care home 25 Care Homes for Older People Page 4 of 28 Brief description of the care home Grosvenor House Nursing Home is situated within close proximity of Alvechurch, Barnt Green, the M42 motorway, Redditch and Bromsgrove. The home has recently been extended, and currently provides nursing care and accommodation for a maximum of twenty-five older people. Three of these places are registered for people with a dementia related illness. Accommodation is provided on two floors with a passenger lift and stairs providing access to first floor rooms. The home has nineteen single, en-suite rooms and three shared rooms all with en-suite facilities. Communal facilities are located on the ground floor and comprise of a lounge, dining room and conservatory and an additional lounge/dining room within the newly built extension. The home does not have internet access, but the organisation can be contacted via email on info@alphacarehomes.com 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: The last inspection at Grosvenor House was carried out during December 2007. The focus of inspections is upon the outcomes for people who live in the care home and includes peoples views of the service provided. The process we use considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at the information that we have received since the inspection This information includes the Annual Quality Assurance Assessment (AQAA). The AQAA is a document completed by the home and provides us with information about the home and how they believe they are meeting the needs of Care Homes for Older People Page 6 of 28 people living there. We sent a number of questionnaires to the home and requested that these were completed by some people living at the home and by some members of staff. We took the information included within those returned into account as part of this report. We looked around the home. We viewed records in relation to some people living in the home such as care records, risk assessments and medication records. We also looked at some records relating to some members of staff and regarding health and safety. We were able to speak to the registered manager . We also spoke to a number of people living in the home, members of staff and some visitors. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 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 9 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. Information about the home is available to help people make a choice about whether they would like to live there. The needs of people who may use the service are assessed prior to their admission to ensure that they and their relatives can be assured that identified needs can be met. Evidence: A copy of the homes service users guide and the homes terms and conditions were available in the entrance foyer of the home. These documents were not assessed as part of this inspection. The AQAA (Annual Quality Assurance Assessment) stated that Pre admission assessments are now more thorough and that Trial visits are offered to potential service users, these have proved to be welcomed from prospective enquirers to the home. Care Homes for Older People Page 10 of 28 Evidence: We viewed the assessment of one person who was recently admitted into the home. The assessment was carried out prior to the admission and contained sufficient information to draw up a care plan. Standard 6 does not apply. Care Homes for Older People Page 11 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. Improvements were needed within the management of medication. The actions taken by the management of the home demonstrated a willingness to improve standards. Evidence: From the AQAA and in discussion with the registered manager it was evident that the home is moving to a more person centred approach. During our inspection visit we spoke to a representative from the local PCT (Primary Care Trust) undertaking a review in relation to RNCC (Registered Nursing Care Contribution). We were told by this person that she has no worries about the service provided. Each person at Grosvenor House had a written care plan. The care plan is a document designed to guide staff about the level of care required by each individual to ensure that their identified needs are meet and people receive the support they require. As part of our visit we viewed a number of care plans, risk assessments and other associated documents. Care Homes for Older People Page 12 of 28 Evidence: Care plans seen were generally up to date and evidence of risk assessments taking place was seen. Some information on daily notes was not always transfered on to the relevant care plan. However staff were knowledgeable about the care needs of people using the service. As part of this inspection we assessed the storage, administration and management of medication within the home. The arrangements for ordering and storing medication have recently changed due to a change in supplying pharmacy. We carried out an audit of medication regarded as controlled. We found the records to balance with the number of drugs held. We became aware of a system in place within the home whereby the night staff were checking the MAR (Medication Administration Record) and documenting what they had found. Following the night shift on 25th November they had recorded checked and correct. However the above entry, that MAR sheets were correctly completed, was not always the case. Between 1st and 18th November (18 days) night staff had recorded no to the statement All MAR sheets completed correctly for 11 of those 18 days. During October we found approximately 13 occasions when staff had found MAR sheets incomplete. The extent of the errors is unknown as staff would have be picked up that they needed to go back to previous day and complete as necessary for example sign the sheet if a gap had been left. We counted the number of signatures on one MAR sheet in relation to a recent course of antibiotics. We found that the medication was not signed into the home however it would appear that a total of 30 tablets were dispensed. However we counted a total of 34 signatures which would suggest that staff had managed to administer 4 more tablets than were prescribed in the first place. These matters were brought to the attention of both the registered manager and the area manager. Both these people took our findings very seriously and assured us that they would be looking into them without delay. We looked at further MAR sheets as part of a later visit and found improvement. We were told that the communication book was no longer used by night staff to record errors on MAR sheets and that all nursing staff had been made aware of the need to Care Homes for Older People Page 13 of 28 Evidence: sign sheets correctly. Care Homes for Older People Page 14 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 are able to join in a range of recreational activities within the home. A nutritious menu is available for people. Evidence: When the manager completed the AQAA the home did not have an activities coordinator due to the post holder transferring to another home. The AQAA did however comment that the home had a varied and comprehensive activity programme including both internal and external activities. A new activities coordinator had commenced duties at the home two weeks prior to this inspection. We saw a list of scheduled events on the lounge door for that week which included: Gentle exercises, sing a long, Practice our carol service, Quiz and Animal mania Staff told us that they would like to see a greater range of activities taking place and that in the past people had spent time making things and playing bingo. People using the service told us that they had in the past made the table decorations on each of the Care Homes for Older People Page 15 of 28 Evidence: dining room tables. People using the service were generally pleased that a new person had started working in the home but also spoke of a desire to have more craft / practical activity taking place such as painting. The activities coordinator told us of her plans for activities which included some craft sessions as well as one to one chats and hand massage. The current weeks menu was on display near to the dining room. The menu for the week showed a varied diet available each day for example salmon and asparagus pie, chicken casserole, roast turkey and sausage casserole. No alternatives were shown on the menu and as the whole week was displayed on one sheet it was not in large print. The tea menu showed that soup and sandwiches were available each day as well as a warm dish. It was noted that these tended to be cheese dishes such as macaroni cheese, cheese omelette and cheesy potato. Care Homes for Older People Page 16 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. Information is available to people using the service however this needs to be consistent to ensure that people receive the correct details. Staff have sufficient knowledge about safeguarding procedures but these are not always fully implemented. Evidence: A complaints procedure within the service users guide made reference to our former Worcester office. As this office closed during the earlier part of 2008 this section of the guide needs to reflect our new contact details. A couple of complaints procedures were also on display. One was old and made reference to the former County Inspectorate (ceased to operate on 31st March 2002). However another procedure was accurate and made reference to our address in Birmingham. The AQAA made reference to complaint cards and that these are available in both the reception area and individual bedrooms. We noted that although these leaflets were freely available a section at the back which mentioned us was not completed. The leaflet was not totally clear about peoples right to contact us as well as the local authority at any time as it suggested a certain order or hierarchy. A copy of the previous inspection report was freely available for people to read. Care Homes for Older People Page 17 of 28 Evidence: A comment book was in the hallway. It was notable that pages were missing. The first entry stated I have to agree with the previous comments. As the previous page was missing it was not possible for us to establish whether the previous comments were positive or not. The previous inspection report highlighted that the inspector on that occasion was not asked for her identification and was invited into the home. Taking this into account it was disappointing that on the first visit of this inspection although we stated to the member of staff that we were from the Commission for Social Care Inspection we were not asked for identification. Staff later acknowledged that they should have done this and realised the importance of asking for identification no matter who people say they are in order to protect people. Staff consulted confirmed that they had received training in adult abuse and they knew the action they should take if they become aware of any actual or potential abuse taking place within the home. Care Homes for Older People Page 18 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. People using the service live in a clean and pleasant home. Continual improvements have enhanced the environment and ensure that people live in a safe and well maintained home. Evidence: On the AQAA we asked for evidence that the home is doing well. We were told that significant investment had taken place and of a vast improvement in the appearance of the communal areas of the home. As part of this inspection we viewed the communal areas of the home plus a small number of bedrooms. We were told by the registered manager and visitors that there have been considerable improvements to the environment since last year. During our visit and within the AQAA the registered manager told us of plans for further improvements in the future such as replacing the flooring in the communal bathrooms. The entrance hall is pleasant and welcoming. Information about the home is on display in this area as well as the area between the front door and the hall. The toilets near to the front door were cool with little or no heat coming from the radiators. The dining room has non slip laminated flooring. The dining room was warm, clean and Care Homes for Older People Page 19 of 28 Evidence: bright. New dining room furniture has been purchased since our last inspection including chairs with gliders to make them easier to move. The manager informed us that they were awaiting new curtains for this area. The main lounge was warm, bright clean and tidy. The room was recently decorated and has new chairs. Large matching pictures adorned the walls. In our previous report we stated that the conservatory was cool. On that occasion we were informed the heating was not effective in this areas and that it has always been a problem. On arriving for the first visit of this inspection we were shown into the conservatory and noted that it was particularly cool. A thermometer in this area showed the temperature to be 11 degrees Centigrade. Although some heaters are situated in this area it does remain cool and therefore unsuitable for use at certain times of the day or until it has warmed up. The main lounge, which leads into the conservatory, was however warm and comfortable. Following comments in our last report window restrictors have been fitted in the conservatory as a deterrent against potential intruders and work has taken place on the fire door to make it easier to open in the case of emergency. The decor along the corridors was good with pictures on display. We were told that these areas are to have new curtains fitted. Although bedroom doors had name plates on them a shower room and a wet room did not. We mentioned to the registered manager that for a period of time the cleaning cupboard had the key in the lock. Although this may have been for a short period of time it is nevertheless important that items are held secure at all times. A wheelchairs store now has a smoke detector in place following a fire audit that took place at the home. Since the last inspection the home has had a sluicing disinfector installed. We did not detect any unpleasant odours within the home. The previous inspection report mentioned a general lack of adapted bathing facilities and that this fact has been identified within previous inspection reports. There continues to be five bedrooms on the ground floor with luxury en suite facilities. We previously reported and this was confirmed during this inspection that the showers in these bedrooms would only be suitable for a person who is fully mobile and would not therefore be suitable if the individual had a physical disability or restricted mobility. We were previously told that it is intended to change these en-suites to wet rooms, this continues to be the plan. Care Homes for Older People Page 20 of 28 Evidence: The laundry leads off from the staff room. The laundry assistant was on leave when we visited. Individual baskets are provided for individuals laundry. The floor in this area has received attention since our last visit. 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. Sufficient staff are on duty to ensure that people using the service have the appropriate level of support they need. Staff are trained to provide them with the skills and knowledge necessary for them to carry out their role. People using the service can have confidence in the homes recruitment process. Evidence: We were told that staffing levels in the afternoon have increased since the last inspection. We looked at the current weeks rota and saw that four carers were on duty throughout the day in addition to a member of staff coming on duty at 7.30 am to assist the night staff for final 0.5 hour of their shift. Two carers are on duty during the night shift. A trained nurse is on duty at all times, the registered manager, when on duty, is in addition to the trained nurse working that shift. The home operates a named nurse and named carer (key worker) system, the names of these people were displayed on bedroom doors. In addition to the above staff other people employed within the home include catering and domestic staff. We saw a compliment which stated: Care Homes for Older People Page 22 of 28 Evidence: I have found all the staff so very kind and helpful with nothing too much trouble. The AQAA informed us that staff continue to receive a robust training programme. We were told that training has greatly improved and that attendance at training session is mandatory. Staff are paid for attending training. Staff responded positively to our questionnaire regarding the training that they have received. While we were at the home one member of staff told us that morale in the home was better now and that staff work as a team. We were told that the induction training is to be longer and more robust. We were told that in one day the induction training covers infection control, adult abuse and health and safety. A training matrix was on display and demonstrated that the vast majority of staff have received training necessary for them to competently and safely perform their duties. We found that, with the exception of one newly appointed kitchen assistant, staff had received manual handling training during 2008. Similarly with the odd exception it was evident that staff have received training in fire awareness, adult abuse and infection control. 50 of the care staff at Grosvenor House have achieved a level 2 NVQ (National Vocational Qualification) therefore meeting the National Minimum Standard. We looked at the file of two recently appointed members of staff and found them to demonstrate that robust recruitment procedures are in place. We saw evidence that checks such as references, PoVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) disclosures are obtained. 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. The home is managed in a way that involves people and seeks their views. People using the service can have confidence that their safety is maintained. Evidence: The AQAA stated that the Registered Manager works supernumerary. She is therefore able to devote her time to the management of the home. The registered manager is a RGN (Registered General Nurse) and has achieved a level 4 National Vocational Qualification (NVQ). She described the home as good. A full time administrator is also in post to support the manager in some of her duties. The manager stated that she is well supported by the staff at the home and head office. We received some positive comments about the manager from staff. One person said that the manager is good listens to you trying to make the home go forward has made things better. Care Homes for Older People Page 24 of 28 Evidence: The most recent Regulation 26 report written on behalf of the provider regarding the conduct of the home, was dated 14/08/08. The report included a number of comments from people using the service such as I am looked after very well. The staff are great. The food is great Comments from staff: The care is very good here Comment from a visiting professional: Very nice environment and atmosphere The results from a survey seeking the views of people using the service dated January 2008 were available. Facilities are available for people using the service to have small amounts of money kept in safe keeping. We checked the balances held in relation to a small number of people. We found the balances to match the records held and that receipts were in place. Records held showed that staff had received a supervision session between October and November 2008. Staff consulted confirmed that they received supervision every two months. We requested a number of records to evidence that suitable health and safety checks and service maintenance is carried out. Included in this sample were fire extinguisher servicing, gas landlord certificate and hoist testing. We found these to be in order. We were told that some concerns highlighted by a fire safety officer during January 2008 were addressed. We viewed the fire log and weekly testing of the fire alarm. We noted that it was not tested for a period of two weeks during October 2008. In addition the testing was not carried out in sequential order which was formal recommended by the fire authority. 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 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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