Care Home: Magnolia Lodge

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What the care home does well The home provides information for people and their carers to decide whether or not Magnolia Lodge may be a suitable home for them. People who live at Magnolia Lodge have individual plans for their personal needs which recognise and respect any risks involved. They are supported to make decisions about their care and their lives. They are supported in activities, in their lifestyles and to maintain relationships with family and friends, as they wish. They are supported in their personal and healthcare needs in the ways they wish. They are appropriately supported with their medication. People are able to make complaints and are safeguarded from possible abuse. They enjoy a homely, comfortable environment which is clean, pleasant and hygienic and benefit from the home being well managed. What has improved since the last inspection? The previous inspection made requirements relating to updating the information the home provides about itself, these requirements were met subsequent to that inspection. What the care home could do better: The manager, supported by CareTech`s responsible individual, must ensure that every individual`s needs are assessed prior to a place being offered, to ensure their needs can be appropriately met at Magnolia Lodge. Although the people who live at Magnolia Lodge are well supported, they would benefit further from staff receiving more training and from their being more qualified staff. Personal support plans have spaces to record how individuals would like their religious and cultural needs to be met. These records were not always completed although the manager and staff demonstrated they knew individuals personal preferences well. Although the people who live at Magnolia Lodge are well supported, they would benefit further from staff receiving more training and from their being more qualified staff. The manager is addressing these areas. Key inspection report Care homes for adults (18-65 years) Name: Address: Magnolia Lodge 42 Hollow Lane Shinfield Reading Berkshire RG2 9BT     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: Amanda Longman     Date: 0 5 0 8 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 Adults (18-65 years) Page 2 of 26 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 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 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 Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Magnolia Lodge 42 Hollow Lane Shinfield Reading Berkshire RG2 9BT 01707652053 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.CareTech-uk.com Caretech Community Services Ltd The registered provider is responsible for running the service care home 10 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 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 10. 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: Learning disability (LD) Physical disability (PD). Date of last inspection Brief description of the care home Magnolia Lodge provides residential care and accommodation for 10 Adults who have learning, and physical disabilities, and is a spacious detached purpose build having undergone a major refurbishment and extension in 2007. Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 0 10 10 Brief description of the care home Magnolia Lodge has ten single bedrooms with en-suite facilities over two floors; rooms on the first floor can be accessed by a lift. An attractive landscaped garden with summerhouse can be accessed from patio doors at the rear of the property. The home is set back on a main road a few miles from both Reading and Wokingham town centres. There are local community facilities nearby and the home has its own transport as well as being on a public transport route to the local town centres. Magnolia Lodge has an up to date Statement of Purpose and Service Users Guide that can be made available on application to the home. The current up to date fees will be included in the final version of this report. Care Homes for Adults (18-65 years) Page 5 of 26 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 peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the service was an unannounced Key Inspection. It was a thorough look at how well the service is doing. We (the commission) received detailed information from the service in the form of an annual quality assurance assessment (AQAA). This provided details of current care provided, as well as plans for the future, details of staff and resident numbers, qualifications and training of staff, and information about the health and safety of the home. A site visit was undertaken on 5 August 2009 by Amanda Longman, regulatory inspector. During this site visit we looked round the home, observed care practices and spoke with people living at Magnolia Lodge and staff working there. We examined care records and staff records. The service has in place policies and procedures relating to equality and diversity and there was evidence that they could meet a range of different needs and choices. The last inspection of this service was undertaken 13 August 2007. Care Homes for Adults (18-65 years) Page 6 of 26 Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 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 9 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides information for people and their carers to decide whether or not Magnolia Lodge may be a suitable home for them. The manager, supported by CareTechs responsible individual, must ensure that every individuals needs are assessed prior to a place being offered, to ensure their needs can be appropriately met at Magnolia Lodge. Evidence: Magnolia Lodge has a Statement of Purpose and Service User Guide providing relevant information for people who live there or who may choose to live there. The home has recently admitted two people temporarily. Although these peoples needs had been assessed, they had not been assessed specifically for Magnolia Lodge. The decision to admit them had been made by the homes owners, CareTech, without input from the manager. It has now been recognised that they are not suitably accomodated and alternative homes are being sought which are more appropriate. However, we discussed with the manager that in her role of registered manager it is her responsible to ensure that the home only admits people if she is confident that Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: their needs can be met. Magnolia Lodge admits people with a wide range of physical and/or learning disabilities which require a variety of skills and knowledge from staff and we discussed with the manager the need to ensure that the home can meet a persons individual needs before offerring them a home there. The manager will discuss this further with CareTech management. We were not able to view the original assessments of other permanent residents, as these had been filed historically. However information on two files which we reviewed for people currently living at Magnolia Lodge, showed how their needs were being met. (See section two of this report.) Care Homes for Adults (18-65 years) Page 11 of 26 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. People who live at Magnolia Lodge have individual plans for their personal needs which recognise and respect any risks involved. They are supported to make decisions about their care and their lives. Evidence: We looked at the plans for care for two people living at the Magnolia Lodge. There support needs and wishes were fully documented, including how they like staff to interact with them and their likes and dislikes. They also contained detailed risk assessments including, for example, fire safety and evacuation, using the bathroom facilities, transfers, using the homes mini bus and activities in the house and in the community. We discussed with two members of staff how they empower people to make decisions who are not able to vocalise them. The staff demonstrated that they knew the people well, their likes, dislikes and preferences. One stated that all the people living at Magnolia Lodge had very different needs and that one had to understand and Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: communicate individually with each person. We spoke with one person living there in detail who stated they can make their own decisions with regard to their lifestyle and care, for example what time they got up or went to bed, how they spent their time and who they saw, and that staff supported them to do this. We also observed this in practice for another individual who was supported in their decisions regarding their daily routine. Care Homes for Adults (18-65 years) Page 13 of 26 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 Magnolia Lodge are supported in activities, in their lifestyles and to maintain relationships with family and friends, as they wish. Evidence: Each person who lives at Magnolia Lodge has a weekly activites schedule and we saw these in the two files we looked at. Activites include organised activites such as trampolining or bowling and non organised activites such as going for a walk or spending time in the garden. Two people went out for a walk with staff whilst we were visiting. We saw evidence that, supported by staff, the people who live at magnolia Lodge had planned a summer BBQ for friends and family. Individual holidays have been booked for some of the people who live there. A daily diary shows clearly planned appoitments and activites for individuals and a communication/ handover book is also used to ensure consistency. The manager stated that people are supported to maintain contact with family and friends as they wish and supported to Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: maintain personal relationships. We confirmed this in conversations with staff and through documented records. We looked for evidence that the home recognises peoples rights and responsibilities. We saw evidence in the minutes of residents meetings and from our observations that individuals are encouraged to participate in the running of the home and the domestic chores. For example on the day of our visit one person was assisting with meal preparation. Everybody living at Magnolia Lodge is registered to vote. Menu planning is done together on a Sunday and a pictorial choice is used to assist with communication. Special diets and individual needs are catered for. For example a religious diet was being catered for and soft food provided for somebody at risk of choking. We observed lunch time. Those people who needed assistance to eat were appropriately assisted but the ammount of interaction between the member of staff assisting and the individual varried. We discussed this with the manager who recognised that this is an area for improvement and will address it. Care Homes for Adults (18-65 years) Page 15 of 26 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. People who live at Magnolia Lodge are supported in their personal and healthcare needs in the ways they wish. They are appropriately supported with their medication. Evidence: We looked at the plans for care for two of the people who live permanently at Magnolia Lodge. These contained details of their personal, physical and emotional healthcare needs together with information about their preferences for how these needs should be met. Records of healthcare appointments were also maintained. From our observations during our site visit we saw that people determine for themselves their daily routines and how their support is provided. For example when and how they wish to be assisted to get up, attend to personal needs and eat. They are appropriately supported with their medication. Personal support plans have spaces to record how individuals would like their religious and cultural needs to be met. In one of the two records we looked at this was left blank and in the other one it was just noted for staff to respect cultural wishes and needs. We discussed this with the manager who stated they had recognised this as a short fall, and that whilst they believed individual needs and wishes were known and Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: respected, it was not appropriately recorded. We spoke with two members of staff who confirmed that they knew people well and were familiar with their personal needs and preferences and with their cultural or religious preferences. We saw that one particular person was supported in their religious and cultural needs. We observed that staff interacted and spoke with individuals respectfully, although the actual amount of interaction varied from different members of staff. The home has a detailed medication procedure in place which is designed to enable the person administering medication to do so without interruption or diversion. This was put in place because there had been several medication errors. The manager has kept us informed of these errors and the procedures put in place to prevent them. We observed the administration of medication during our site visit. The medication was administered by someone who has been trained to administer medication and the procedure was followed appropriately. Medication was appropriately stored and medication records were accurate. Individual administration records contain photographs of the individual people. Later in our site visit we saw evidence that all staff in post at the time had received renewed medication training in March 2009. Care Homes for Adults (18-65 years) Page 17 of 26 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 who live at Magnolia Lodge are able to make complaints and are safeguarded from possible abuse. Evidence: Magnolia Lodges Service User Guide was reviewed in June 2009 and includes the complaint procedure. This is also provided in an easy read format. The manager stated that the home welcomes comments and complaints from the people who live there or their representatives. The home has received two complaints in the year previous to our inspection, both of which were dealt with appropriately. Magnolia Lodge has an appropriate procedure in place for safeguarding vulnerable adults. All staff have received training in the safeguarding of vulnerable adults as part of their induction training. Staff then go on to do a more detailed training session and not all recently recruited staff have done this yet. At the time of our site visit the manager was in the process of arranging this. Staff we spoke with during our site visit were familiar with relevant procedures and support plans were written in such a way as to safeguard people. For example risk assessments relating to outings and wheelchair use. Their have been two safeguarding issues at the home during the 12 months preceeding our inspection and both of these were appropriately dealt with. Care Homes for Adults (18-65 years) Page 18 of 26 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. The people who live at Magnolia Lodge enjoy a homely, comfortable environment which is clean, pleasant and hygienic. Evidence: Magnolia Lodge is a modern, comfortable house. The bedrooms are large with space for aids and adaptations and all have ensuite facilities. There are also bathrooms for assited bathing which have a variety of hoists and adaptations. We were invited by one of the people who live there to view their bedroom. It was homely and comfortable, suitably adapted, and furnished with personal possessions. On the day of our visit the home was spotlessly clean. All staff receive introductory infection control training as part of their induction. Seven out of ten current staff have received fuller training in infection control and the manager is planning for the remaining three to receive this training as soon as possible. The home received the maximum five stars from the environmental health department for its most recent kitchen inspection. Care Homes for Adults (18-65 years) Page 19 of 26 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 people who live at Magnolia Lodge are well supported. People would benefit further from staff receiving more training and from their being more qualified staff. The manager is addressing these areas. Evidence: The home has been following a prgramme of recruitment and at the time of our site visit 10 out of 19 permanent posts had been filled. In addition the home now has its own dedicated bank staff of seven employed by CareTech. This has led to much less use of agency staff and more consistency for the people who live at Magnolia Lodge. Of the current permanent staff two currently hold the National Vocational Qualification to level 2 and one person has commenced level three. This is an area for improvement which the manager plans to address now more permanent staff are in post. The home has an appropriate recruitment procedure in place but we were unable to examine recruitment records as these are stored at CareTech head office. We discussed with the manager the need to use a proforma to provide evidence that all appropriate recruitment procedures had been followed. We saw the training matrix for the home. It details all staff, the training they have received, what is due and what is planned. All permanent staff have received training Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: in manual handling, first aid, food hygeine, fire training and epilepsy. They have all received induction training covering safeguarding vulnerable adults. Three out of the ten have received further training in this area and further training is being planned for the other staff. In addition to the permanent staff there are seven flexi or bank staff who have all received induction training but not all have yet received further training in all mandatory areas. We saw evidence from memoranda that the manager is proactive in requesting and planning training for her staff. Staff we spoke with said that training is essential because of the diverse range of needs and disabilities of the people who live at Magnolia Lodge. They stated that the training provided was of a good standard. The people who live at Magnolia Lodge that we spoke with stated that the staff are well trained and provide support in the way they wished to receive it. Care Homes for Adults (18-65 years) Page 21 of 26 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 people who live at Magnolia Lodge benefit from the home being well managed. Evidence: Magnolia Lodge is managed by an experienced person who is qualified and registered with us to manage the home. Staff and people living at the home spoke highly of the manager. We saw that the manager is proactive in continually improving the home, specifically with regard to recruiting permanent staff and training. The manager is conscious that the home currently caters for a large range of differing needs and will pursue with CareTech the need to ensure that a persons individual needs can be met by the skills and resources of the home prior to a place being offerred. The manager always keeps us informed of any incidents which may impact on the welfare of anyone living at Magnolia Lodge. The home seeks the views of the people who live there through monthly residents meetings. We saw evidence of these. The minutes record the areas discussed and views expressed both verbally and non verbally. An annual quality assurance survey is undertaken annually by CareTech. Surveys are sent to residents, their representatives Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: and professionals involved with the people who live there. The results are collated by head office and sent to Magnolia Lodge. The manager uses this and information from residents and staff to formulate an annual development plan to continually improve the service offerred at Magnolia Lodge. The most recent improvement plan included service users development plans, staff training and planned maintenance for the building. Magnolia Lodge has health and safety policies in place including fire safety, control of substances hazardous to health, dealing with violence and aggression, first aid and food safety, all of which were reviewed in January 2009. All electrical and other equipment has been serviced in line with manufacturers recommendations. Care Homes for Adults (18-65 years) Page 23 of 26 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 Adults (18-65 years) Page 24 of 26 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 Adults (18-65 years) Page 25 of 26 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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