Care Home: Laurieston House

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Laurieston House 118 Hady Hill Chesterfield Derbyshire S41 0EF 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: Brian Marks Date: 1 2 0 5 2 0 0 9 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 31 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Laurieston House 118 Hady Hill Chesterfield Derbyshire S41 0EF 01246238213 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dr Bolegowda Narayana Swamy,Nanda Swamy care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: Bedroom 3 will not be used as Service User accommodation once the present occupant has vacated the room. Date of last inspection 2 6 0 6 2 0 0 7 A bit about the care home The Home can look after 5 people. Chesterfield Care Homes for Adults (18-65 years) Lauriston House is near Page 4 of 31 Chesterfield town centre. X2 The Home has bathroom and toilet facilities on both floors and is run on domestic lines. People are encouraged to use community facilities, including day centres. It costs 355 pounds per week to live at the home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home X We came to the home without telling the manager before we came and spent part of a day there. We had received a lot of information about the home from the manager, the staff and people living at the home before we came. The information we received before we came helped us plan what we would do when we arrived. At the home we spoke to the manager who told how things had changed since we last came. We looked at a lot of papers and documents in the office that told us about the home. X1 We spoke to the staff who was working during the time we were at the home. Care Homes for Adults (18-65 years) Page 7 of 31 X2 We spoke to two people who live at the home about their rooms and how much they enjoy living there. We walked around the home and saw how it had been improved. This is the first inspection of this home since 26 January 2007 - two years ago. What the care home does well 1 The people in charge of Lauriston House are making it better for everybody and a new person has recently come to live there. The people in charge of Lauriston House are always listening to the people who live there and have changed things in the ways that they want. People from outside, such as doctors, nurses and social workers, are regular vistors to the home and they have helped staff at the home to look after people properly and to be healthy. Staff at the home work well to give people a good life and they get regular training to help them do things even better. Care Homes for Adults (18-65 years) Page 8 of 31 Staff look after people properly and treat them with respect. The manager at the home does a good job. The home has been made a nicer place to live in by improvements to rooms the areas that everybody uses. People living at the home have said what they want changed about the building. What has got better from the last inspection The people who run the home have done everything they were asked to at the last inspection and the way they run it has been improved. The home is better place to live and this includes the improvements to the building. Care Homes for Adults (18-65 years) Page 9 of 31 Staff have had more training which has helped them do their jobs better and some have achieved an approved qualification. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Brian Marks CQC Capital Park Fulbourn Cambridge CB21 5XE Care Homes for Adults (18-65 years) Page 10 of 31 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 Adults (18-65 years) Page 11 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The support and care needs of individuals are properly identified before they move to the home, to ensure that the home is right for them and that their wishes and needs are properly planned for. Evidence: In the AQAA we were told how a high standard of care is identified with the professionals involved in peoples lives, the persons family and particularly the person themselves. Good communication between everybody involved allows for any problems and issues to be resolved quickly. Since the last inspection one new person has come to live at the home in 2008 and, from looking at his care records, we were able to confirm that detailed assessments of need were carried out before he came to live at the home. These were completed by staff from the home and from Adult Social Services. He told us that he also came to visit regularly and after a period if time decided that I got on well with everybody so came to stay. A lot of information was available about his background, interests and preferences, and a number of different professionals contributed to the moving-in Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: process. The care records of somebody who has lived at the home for two years were also looked at and these also contained documents that indicated detailed assessments being carried out before she moved in. Each of the files looked at held a record that indicated that they had been monitored by the manager every month to indicate that actions and interventions by staff are based on up to date information. Care Homes for Adults (18-65 years) Page 14 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents care needs have been assessed, risk factors identified and care planned in ways that reflect their individual preferences and abilities. Evidence: In the AQAA we were told that all the people living at the home have care plans, which are updated and revised at regular intervals to take account of peoples needs and wishes. We were also told that regular meetings with the people living at the home allow the manager and staff to discuss and change things as necessary. The two care records we looked at in detail had comprehensive personal care plans as well as a more strategic plan prepared by a social worker from the Adult Services Department. The plans included actions for staff to take in all key areas such as accommodation, personal assistance, leisure, health and domestic, as well as a number of records such as weight charts, daily routines and logs, and of the involvement of outside professionals. There were also a range of risk assessments in place to support safe working, background histories and personal profile, along with agreements and consent forms signed by the individual concerned. All of the records Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: looked at contained documentation that indicated that there had been a case review with a representative of the Adult Social Services Department, which had taken place annually, as well as a sheet which indicated a monthly review carried out by the manager. We spoke to all of the people living at the home at the end of the inspection and they said that they were very happy at the home and they all get on really well together, were good friends. When we spoke to the manager and members of staff they told us that they were committed to help them lead the lives that they want; they were all observed interacting together in a relaxed and friendly manner. There is a varied degree of independence amongst the current group of people living at the home and nobody requires much support with personal care. They are also encouraged to help with domestic activities around the home and one told us about cleaning his room and helping with the weekly shopping. Care Homes for Adults (18-65 years) Page 16 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the home have continued to enjoy social and leisure activities of their choice, so that independence and decision making are encouraged and they enjoy as many opportunities as possible. Evidence: In the AQAA we were told about a range of activities enjoyed by people living at the home, and that activities such as outings and day centre attendance are routinely discussed to make sure that they are suited to their needs. Discussion with staff and observations made during the visit confirmed that the daily routines of the home continue to be flexible and residents were seen in the communal rooms and bedrooms during the inspection. All five people spend their week at structured day services, operated by Social Services and voluntary groups, and they have attended these for some time. It is through this network that they had become acquainted and all are good friends because of this long term contact. The particular Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: activities that people enjoy are described in their care plans and outside professionals have, in some cases, been involved in making arrangements. Informal leisure activities are well supported and people have continued to enjoy activities within the wider community with staff support. They told us that visits to local shops, pubs, cinemas and restaurants are regular and we were told about arrangements for holidays that had been individual the previous year, but that this year a group trip to Blackpool was planned. Two of the people have retained regular contact with their families and one told us how he goes to stay regularly with his sister, who also visits him weekly. The others have lost contact with their families. The catering arrangements at the home are very domestic and flexible in style and we were told that the 3 week menu is a guide for the evening meal, as everybody gets a good meal at their day centre in the middle of the day and they are not always wanting a fully cooked meal when they come home. The feedback received was positive about the meals provided and we were told that we have whatever food we fancy and theres always a good roast at the weekends. The manager told us that the written menu acts a guide to avoid repetition and that meals can be changed on the day if the group decides. She also told us that home cooking and healthy eating are the principle they try to work to, and fresh fruit and vegetables were seen in store. The manager does a weekly shop at the local supermarket and people living at the home usually help out with this. Overall food stocks seen in the kitchen and storage areas were satisfactory. In the AQAA we were told how the regular meetings with the people living at the home influence decisions around menu planning and mealtimes. Care Homes for Adults (18-65 years) Page 18 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The personal and health needs of people at the home are dealt with in a satisfactory way, and they continue to receive good support from outside professionals, so that they have access to local services like everybody else. Evidence: In the AQAA we were told that staff training around health care needs had been maintained and that records of regular health checks have been improved and kept up to date. Since the last inspection one person has moved into the home and it was agreed as part of the admission process that he was suitable and did not require any additional support compared to the others; the management of the home are clear about the boundaries of need they can be responsible for. Care plans indicated that none of the people living at the home require anything more that low level support or prompting with self care; the two we spoke to at length described the daily help they receive and how it was done carefully and properly. As reported before they are encouraged to do as much for themselves as they can and this is reflected in the personal plans we looked at. Care plans confirmed limited involvement of local Learning Disability Services professionals, although all have support from a social worker and one Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: regularly sees a psychiatrist at a local health service clinic. People also have routine access to general healthcare services such as GP but the manager confirmed they were generally all in good health. Written risk assessments on care files cover such areas as hot water, bathing and going out alone and any special medication needs; there were regular monitoring checks taking place on weight and personal care activities. We saw from written records that everybody receiving prescribed medication require staff help with its management, although only two people were in receipt of any at the time of the inspection. Examination of the arrangements for the receipt, storage and administration of medicines indicated that these are generally satisfactory although there are handwritten instructions had not been signed or dated and a number of packages of drugs in the store cupboard were not required and stocks were building up. Medication is stored securely and the home uses a Monitored Dosage System for the dispensing of most of the medicines in use; entries in the written records had been made properly. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the home are protected by having their rights to complain upheld and by staff who understand their responsibility to report concerns and to safeguard vulnerable people from harm. Evidence: In the AQAA we were told that people are supported to express their views and concerns as they arise and that the complaints procedure is accessible to residents and their families. We were also told about staff training in respect of safeguarding vulnerable people and how they are given information about any changes in procedure and legislation. The home has a comprehensive complaints policy and procedure that is on display, and this includes an easy read summary to make it more accessible. The manager reported that there had been no formal complaints made by anyone since the last inspection, but the size of the home is small and the manager is in the home most days so that concerns and problems are dealt with immediately and informally as they arise. The home has a copy of the statutory safeguarding procedures and other national guidance, and records indicated that the manager had attended training or briefing sessions provided by the Local Authority, which had been cascaded on to the established staff. There has been one incident, reported at the end of 2008, which resulted in a full investigation under these procedures by Social Services and Police; Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: the manager and staff involved had acted properly to report and protect as they are required. The outcome of the investigation did not substantiate any ongoing issues for the home to resolve, and the member of staff involved subsequently left the employment of the home. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the home have continued to benefit from a homely domestic style environment that is equipped to meet their needs. Evidence: In the AQAA we were how the home is a comfortable and homely environment and also about the improvements that have been made in the garden areas and about the ongoing redecoration of rooms. We made a brief tour of the building and found it clean, tidy and offering domestic style accommodation which people occupy in single rooms with all the required facilities. Good standards of decoration have been maintained and the manager described how they had just completed a programme of improving all the fire doors in the home so that they met the required standards of the Fire Officer. All the bedrooms are very much to each occupants individual style and furnishing, and all have televisions and other electric equipment. They are personalised with pictures, personal mementoes and photographs. The manager described a continuous programme of decoration, and recent improvements to the garden include the creation of a space for sitting out, and improvements in the greenhouse to allow people to take part in growing plants and vegetables. Staff are mainly responsible for cleaning and domestic arrangements around the building, but are helped by people tidying their Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: own rooms. The laundry is domestic in style and capacity and clothes are laundered daily or as needed. Standards of cleanliness and hygiene were good and everybodys clothes were clean and appropriate. As mentioned in previous reports the home would not be suitable for people with substantial physical disabilities. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has established systems for recruiting, training and supporting its staff, so that the interests of the people in their care are protected and their overall welfare is promoted. Evidence: In the AQAA we were told about staff training, induction and deployment and how these support staff to meet the needs of the people living at the home. The home employs three part time support workers, one of whom started at the home two months before the inspection. At the time of the inspection the manager had continued to cover half of the day and sleep in shifts throughout the week. We looked at the recruitment files of this last worker to be employed at the home and this indicated that a standardised procedure is in place and that all the proper references and checks were obtained. We looked at the training records for staff and some of the certificates that had been received by the manager and these indicated that good standards of training had been maintained. The new staff member, who was on duty during the inspection, told us about the induction training he had received, and about plans to enroll on a National Vocational Qualification (NVQ) level 2; the other two staff have both achieved level 3 in the NVQ which is in excess of the standard and is to be commended. Records did Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: not indicate that the staff had received any awareness training about the needs of people with a learning disability which could help further develop skills, and also that none of the training programme has been structured under nationally approved protocols. The manager and staff on duty described how the staff team had stabilised and how they had built up a lot of knowledge about the people at the home and described how they had come to understand and interpret those who had difficult communication skills. The staff member on duty told us his working experience had been very positive so far. If I have any problems we work round them and sort them out together. During our discussions with the people living at the home they told us that we get on well with all the staff and that staff only help me with what I need help with; I feel safe here. Whilst the staff work quite independently for a lot of the time, we were told that they have access to good support from the manager. We looked at the records for formal meetings between manager and staff (supervision) and these indicated that the established staff had had four such meetings in the past 12 months, which is in line with their part time status. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is a well-managed and safe environment in which to live and work. Evidence: In the AQAA we were told how the owners provide a well managed home that offers a safe environment for residents and staff. The home is described as having a warm, friendly, family atmosphere that promotes the privacy, dignity, independence and self esteem of the people living there, allowing them to reach their full potential. During the inspection, the manager confirmed that she had completed the Registered Managers Award qualification at NVQ level 4 in 2008, and that she has continued to take up training opportunities with the other staff as they have been arranged. As reported above she is supported by a staff team that now enjoys improved stability, and the resulting consistency has allowed for the family concept of care to be established. There was a relaxed atmosphere at the home and the people spoken to were equally positive about the manager as they were about the other staff. The manager described methods by which people living at the home give feedback about their care as being mostly informal, but she has recently carried out a stakeholder survey of all of the key outside people involved with the home. We saw the results of Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: this which rated the home as good in all areas, along with the results of a staff assisted survey of the people living at the home which was equally positive. One of the people living at the home told us about being able to speak out about the ways things are run when they all meet together, and the member of staff we spoke to also told us that they meet with homes owners irregularly. The manager told us about standards of health and safety activity and regular servicing of equipment at the home, and observations made around the building and a sample of fire safety and servicing records indicated that the home was hazard free at the time of the inspection. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 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 Description 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 Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Handwritten entries on the medicines administration record should be signed and dated by the person carrying this out, so that a clear audit trail of responsibility is maintained. All medicines that are excess to requirements should be returned to the pharmacy so that the homes systems remain safe for all concerned. The homes training programme should underpin the principles and protocols of the national Learning Disability Award Framework so that staff are working in ways that reflect modern principles and practices. 2 20 3 35 Care Homes for Adults (18-65 years) Page 30 of 31 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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