Care Home: Harrias House

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What the care home does well There is information available to prospective residents and their families about the home. They are encouraged to visit and stay for short periods before deciding whether the home is the right place for them. Their care and support needs are assessed and agreed with them before they move to the home. Residents register with a local general practitioner or keep their own general practitioner if they wish. The home supports them to meet their health and personal care needs in a manner which protects their independence, autonomy and privacy. People are supported to manage their own medication if they wish or the home may manage this on their behalf. People can choose how they spend their day and are supported to take part in activities in and outside of the home if they wish. The standard of food is good meeting residents` social and nutritional needs. Residents were complementary about the food saying `the chef likes to chat to us all individually` and when asked what the home does well another said `the food`. There are complaints and safeguarding policies and procedures in place which are well advertised. Everyone who returned the questionnaires and those spoken to on the day said that they knew who to speak to if they had a concern and that they knew how to make a formal complaint. Staff had had training in safeguarding older people and were clear about the action they should take and who to report concerns to. The home is in an elegant Edwardian building and there is an ongoing programme of redecoration and refurbishment. Rooms vary in size and residents are encouraged to furnish them with their own furniture and belongings. Every room was individual and clearly reflected the lifestyle and personality of the resident. There is a consistent motivated staff team. Residents were positive about the staff commenting `they are very helpful and always there` and `they are generally very good at everything I need`. The recruitment procedures are thorough and the home is committed to supporting staff to gain the skills and knowledge that they need to care for older people. The home is managed by a small local charity which has a committed Board of Trustees and Management Committee. The home`s manager is experienced and holds the relevant qualifications. The home prides itself on providing individual care and residents views are invited to determine how the home is run. What has improved since the last inspection? The care plans have improved and now contain greater detail as to peoples` health and personal care needs and preferences and the way in which they would like them to be met. Staff training has been increased and all senior staff have received updated medication training. There has been an ongoing redecoration and refurbishment programme and some of the ensuite bathrooms have been converted to shower rooms.The home has a copy of the local multi agency safeguarding procedures and has updated their policies to reflect these. The home`s own satisfaction surveys show higher scores for the care and the standard of food, with most people rating these as excellent or very good. What the care home could do better: The home should purchase a medicines cupboard which meets the requirements for the storage of controlled drugs in order that they could be stored safely should any one be prescribed them. There is advice available from the Royal Pharmaceutical Society on their website www.rpsgb.org.uk and on our website www.cqc.org.uk about the safe storage of controlled drugs. The home should consider introducing a formal nutritional risk assessment tool and falls risk assessment tool to help identify those who are risk of nutritional deficiency or of falling to minimise the risk. The organisation should develop written policies and procedures to guide staff on the management of resident`s money, valuables and financial affairs and gifts to staff, to safeguard residents from potential financial abuse. The responsible individual should record the findings of the monthly quality assurance visit. These should be kept in the home to be seen at inspection. Key inspection report Care homes for older people Name: Address: Harrias House Hedgerley Lane Beaconsfield Bucks HP9 2SD     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: Chris Sidwell     Date: 2 4 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 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 27 Information about the care home Name of care home: Address: Harrias House Hedgerley Lane Beaconsfield Bucks HP9 2SD 01494674204 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager@harriashouse.co.uk Beaconsfield Housing Society Limited The registered provider is responsible for running the service care home 19 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Harrias House provides care for 19 service users. It is situated on the edge of Old Beaconsfield and is an elegant building with extensive, and well-maintained grounds. It provides a welcoming and homely residence for the older person. Each bedroom is spacious and can be personalised by the occupant. The Beaconsfield Housing Trust, which manages the home, has an active board of trustees who take an interest in the Care Homes for Older People Page 4 of 27 0 Over 65 19 Brief description of the care home home. There is an experienced manager and care team. Care Homes for Older People Page 5 of 27 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 was undertaken on the 3rd July 2008 This inspection was conducted over three days and included a review of the information we hold about the service and an unannounced one day visit to the home on the 24th June 2009 of six hours. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment (AQAA) in which she described the way in which the home ensures that the views of people who use the service are included in what they do, the way they ensure equality and diversity is respected, what they do well, the evidence to show it and their plans for improvement. Questionnaires were sent to the home for distribution to residents, staff and visiting professionals. Ten residents, eight members of staff and two healthcare professionals returned these. Residents were spoken to on the day of the unannounced visit. Discussions took place with the Chairman of the Trustees, Care Homes for Older People Page 6 of 27 manager, care and ancillary staff. Care practice was observed and the care of a small number of residents was followed through in detail. A tour of the home and examination of records was also undertaken. The homes approach to equality and diversity was considered throughout. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? The care plans have improved and now contain greater detail as to peoples health and personal care needs and preferences and the way in which they would like them to be met. Staff training has been increased and all senior staff have received updated medication training. There has been an ongoing redecoration and refurbishment programme and some of the ensuite bathrooms have been converted to shower rooms. Care Homes for Older People Page 8 of 27 The home has a copy of the local multi agency safeguarding procedures and has updated their policies to reflect these. The homes own satisfaction surveys show higher scores for the care and the standard of food, with most people rating these as excellent or very good. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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. There is information available and the opportunity to visit the home to help people decide whether they wish to move to the home. Peoples health and support needs are assessed before they move to the home, to ensure they can be met. The home can meet peoples faith needs. Evidence: There is information available to prospective residents in the form of a residents guide, which describes the services provided by the home and a home brochure. Prospective residents and their families are welcome to visit the home and stay for a trial period before deciding whether the home is for them. The home also offers respite care for people who wish to stay for a short period perhaps whilst a family member is on holiday. The manager and staff said that this was also a good way for people to get to know the home. The care files of three residents who have moved to the home since the last inspection were checked. They had been invited to the home to look around and had been assessed by the manager to identify with them their Care Homes for Older People Page 11 of 27 Evidence: needs and wishes for care. The assessment documentation prompts staff to take note of peoples faith wishes as well as their health and care needs. The homes residents guide states that the home offers short stay and convalescent care. The home does not offer intermediate care for those requiring rehabilitation. Care Homes for Older People Page 12 of 27 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. Residents diverse personal, health and medication needs are met in a manner which protects their dignity, promoting their wellbeing. Evidence: The care of three residents was followed through. All had comprehensive care plans which had been updated regularly with them and with their families. Residents diverse healthcare needs were recognised and recorded. Risk assessments had been completed to minimise the risk to people who may use the stairs, go out in the garden and move around their rooms unaided. The risks associated with residents moving and handling needs had been assessed and actions to minimise these recorded. Residents dietary needs had been recorded although a recognised nutritional risk assessment tool is not used. The care plans of those residents whose care was followed through showed that they had all maintained or put on a little weight since moving to the home. There was evidence in all the files to show that residents see a general practitioner and other members of the local primary healthcare team regularly and are supported to visit hospital outpatient departments when necessary. People who Care Homes for Older People Page 13 of 27 Evidence: returned the questionnaires said that they always or usually received the care that they needed. They commented that the staff are very kind, they are generally very good at everything I need and the staff are friendly and supportive. Both health professionals who returned the questionnaires said that the home sought and acted on their advice. There are medication policies and procedures in place and the staff spoken to were aware of these. Records are kept of medication delivered to the home and returned to the pharmacy. Residents individual medication administration records were completed in full and appropriate steps were taken to ensure that supplies were received regularly. One resident manages their own medication. A risk assessment was in place. There is safe storage in their rooms for people who keep their own medication with them. The residents spoken to said that they received their medication regularly and were happy for the home to manage this on their behalf. The staff spoken to said that medication was never given covertly. If a resident did not want to take their medication, this would be recorded. One lady consistently declined to take her medication. She was assessed by the general practitioner and a way forward agreed. Medication storage is generally satisfactory. There were no surplus stocks. Medication which should be kept at low temperatures is stored in a dedicated fridge and the fridge temperatures are monitored to ensure they are within the recommended range. There are no controlled drugs being taken at the moment. The home does not have a cupboard which meets the requirements of the Misuse of Drugs Act and to store controlled drugs and are advised to purchase one, in order that these drugs could be stored safely and in line with current legislation should any one be prescribed a controlled drug. There is advice available from the Royal Pharmaceutical Society on their website www.rpsgb.org.uk and on our website www.cqc.org.uk about the safe storage of controlled drugs. Residents said that care staff were discrete and that all care is given in residents rooms. They are addressed by their preferred name and had been supported to maintain their personal hygiene, to wear their own clothes and to have their hair dressed as they wished. The healthcare professionals who returned the questionnaires said that they felt the service respects peoples privacy and dignity and said that they felt the home supported people to live the life they chose, wherever possible. Care Homes for Older People Page 14 of 27 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 can choose how they spend their day and are supported to take part in activities in and out of the home if they wish. The standard of food is good meeting residents social and nutritional needs. Evidence: Residents spoken to said that they had a choice as to when they got up and when they went they went to bed and how they spent their day. A new activities coordinator is starting soon. The carers support residents with a range of activities, including musical entertainments, quizzes, crosswords and walks in the garden. One resident commented that she particularly liked the musical entertainment. The home prides itself on being a part of the local community. Residents are supported to attend local clubs if they wish. On the day of the unannounced visit the local vicar came to give communion. She said that in her opinion the home stood out because of the love and attention given to residents. The chef was knowledgeable about residents likes and dislikes. There is a varied menu and all food is home cooked. There is a choice of menus at each meal. There is an attractive dining room with dining tables. These were decorated with flowers and Care Homes for Older People Page 15 of 27 Evidence: well laid with tablecloths, cutlery and drinks and glasses. Residents have a choice as to whether they eat alone or with others. There was no one needing a special diet for health or cultural reason at the time but the chef said he would be able to prepare one if necessary. Everyone who returned the questionnaires said that they always or usually enjoyed the food. One said that the chef likes to chat to us all individually and when asked what the home does well another said the food. Care Homes for Older People Page 16 of 27 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 who live at the home are protected from harm and their concerns are listened to and addressed. The organisation should develop written policies and procedures to guide staff on the management of residents money, valuables and financial affairs and gifts to staff, to safeguard residents from potential financial abuse. Evidence: There are complaints policies and procedures in place. These are explained clearly in the residents guide and displayed in the entrance hall to the home along with information about local advocacy services. Eleven people returned the questionnaires and all said that there was someone they could speak to informally if they had a concern and that they knew how to make a formal complaint. A complaints record is kept although there have been no complaints since the last inspection. The manager said that they responded to any verbal concerns immediately. This was confirmed by the residents spoken to. The home has a copy of the local multi agency safeguarding policies and procedures and staff have a received training in safeguarding vulnerable people. The homes policy and procedure has been updated to reflect this. There are whistle blowing policies and procedures in place. The staff were very clear that they would report any concerns to the manager and also said that the Trustees visited the home regularly and they would have no hesitation in raising concerns with them. The home does not currently have any written procedures to guide staff on the safety of residents money and valuables and not accepting gifts which should be considered. Care Homes for Older People Page 17 of 27 Evidence: The staff when spoken to said that residents had safe storage in their rooms if they wished but that the home did not manage anyones personal finances and did not store valuables on behalf of residents. Staff spoken to also said that they would not accept gifts. Care Homes for Older People Page 18 of 27 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 is elegant, clean and well maintained providing a pleasant environment for people to live in. People have a choice as to whether they use the communal areas, where they sit and how they spend their day, promoting their independence and autonomy. Evidence: The home is situated in an attractive Edwardian building and is set in large well maintained gardens. There is an ongoing programme of maintenance and redecoration. There are a number of sitting areas, television room and dining room Residents rooms vary in size and in some cases residents have a bedroom and sitting area. Although none of the rooms are double they can be converted for the use of married couples if necessary. Residents are encouraged and supported to bring their own furniture to furnish their rooms and most had chosen to do so. Rooms were homely and clearly reflected the wishes and personality of the residents. Staff respected residents privacy and their wish to keep their room as they wished. There are attractive gardens although there is a small step leading to the garden and the paths are uneven. Not all residents can access the gardens independently and walks in the garden have been incorporated into the daily activities to support residents to go outside if they wish. The home was spotlessly clean on the day of the unannounced visit and there were no offensive odours. The home has an infection Care Homes for Older People Page 19 of 27 Evidence: control policy and procedure and the laundry is well managed. Care Homes for Older People Page 20 of 27 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 receive care from kind, well trained staff who can meet their diverse health and care needs in a timely way. Recruitment procedures are thorough protecting residents from unsuitable carers. Evidence: There is a consistent care team. There are four carers on duty in the mornings ,three in the afternoons and two at night. Residents told us that they always received the care and support they need , that staff listen and act on what they say and that staff are available when they need them. They made positive comments about the staff team saying they are very helpful and always there and they are generally very good at everything I need. Staff felt they had time to care for residents and one said that she felt that the good levels of communication helped them to maintain a high standards of care. There is an ongoing training programme. Training records were in good order and showed that staff training in safe working practices, was up to date. The home has joined a cluster group of homes who are working together to take advantage of shared training opportunities and financial support. There are fifteen carers, eleven of whom hold the National Vocational Qualifications in Care at Level 2. Care Homes for Older People Page 21 of 27 Evidence: One new member of staff has started work since the last inspection. Their recruitment file was checked and held the required documents. There was evidence of the staff members identity had been checked. A Criminal Records Bureau disclosure and two references had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. There was evidence that staff had had an induction programme. Staff told us that they were given the opportunity to attend training and one said that there is good teamwork and support from senior staff. Care Homes for Older People Page 22 of 27 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 well managed in the interest of the residents. Evidence: The home is managed by a small local charity the Beaconsfield Housing Trust. There is an active board of Trustees and management committee. The Chairman of the Trustees and others visit the home regularly. On the day of the unannounced visit they were supporting the manager with interviews of prospective staff. The manager has been in post for seven years. She holds the National Vocational Qualifications in Care and Management at Level 4 and is registered with us. She said that she had an open door policy and staff confirmed that she was very approachable. The atmosphere in the home was relaxed and courteous. The home has a quality assurance policy and seeks residents and their familys views on a regular basis. The Chairman of the Trustees visits the home at least weekly. He has not been recording these visits on a monthly basis as required but has agreed to do so. Records of untoward events are kept including accidents and are monitored by Care Homes for Older People Page 23 of 27 Evidence: the Trustees. The home does not manage residents financial affairs. Residents have locked storage in their rooms and may have a key to their room if they wish. There are health and safety policies and procedures in place and health and safety matters are discussed at staff meetings. Maintenance records were up to date and there was evidence that essential safety checks of services and equipment are undertaken. Water temperatures are tested regularly and there are window restrictors to upper floors to reduce the risk to residents of falling. The fire risk assessment had been updated and fire safety checks were made. The training records showed that most staff members had had training in safe working practices, including moving and handling, fire safety and infection control. Care Homes for Older People Page 24 of 27 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 25 of 27 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 26 of 27 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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