Care Home: Manor Road, 2

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What the care home does well Staff were friendly and relaxed with the inspector and were keen to discuss their work and the care needs of people who use the service. The home and staff create a positive atmosphere, which people commented upon and which is welcoming to families and visitors. The home has links with supporting health professionals, who give good health support to people who use the service. A good range of social activities takes place both within and outside of the home and this gives people who use the service the opportunity to meet, mix and socialise with others. The food provided is of a good standard, with good choice and variety. The dining room is well laid out with good staff attendance enabling people to have a pleasant and social mealtime. There is a complaints procedure and in addition the views of people who use the service are actively sought. They felt their views were listened to and acted upon. The home is furnished and decorated to a good standard and provides comfortable and pleasant surroundings for people who use the service. Individual bedrooms are well furnished and the communal areas are well decorated and used for a range of social events. The home is well staffed with a skilled, consistent and trained staff team giving security to people who use the service. The service gives good support to enable individuals to maintain and develop personal and family relationships. More than fifty percent of staff have undertaken National Vocational Training in Care at level Two or above and exceed the minimum standard, ensuring people who use the service receive care from a skilled and knowledgeable staff team. People who use the service and their relatives comments included `I feel safe here` `everyone is lovely when they speak to me` `all the staff are so nice` `I feel warm and secure here` `I am very happy` `we were unanimous in our decision that Manor Road was excellent. Over the past two years we have had not reason to regret that decision due to the dedicated care of the manager and her staff` `Manor Road looks after my mam very well` `All the staff are very caring` `they see to all her needs` `They are very good to relatives as well` `we can talk to the manager anytime we want and she listens`. People who use the service live in a home, which is well run and managed. What has improved since the last inspection? The home has continued to develop how they take into account the views of residents and their families by the use of meetings and surveys. The home continues to be redecorated and refurbished providing a comfortable and pleasant environment for residents. What the care home could do better: Preadmission assessment and documentation must be completed for all residents to ensure that the home can meet their identified needs. All care plans must reflect the individual needs of residents and be reviewed and updated regularly to ensure that staff have access to all information. Nutritional assessments must be undertaken, reviewed regularly and any actions identified and acted upon, this includes the monitoring of resident`s weights and seeking health input as necessary, this will improve the health and welfare of residents. The shaft lift must be repaired/replaced to enable residents to have safe access to all areas of the home. Staff supervisions must take place regularly this will give a management overview of staff performance and identify any areas for staff development. Fire alarms and equipment must be tested at the recommended timescales this will help protect residents, staff and visitors. Key inspection report Care homes for older people Name: Address: Manor Road, 2 2 Manor Road Tynemouth North Shields Tyne & Wear NE30 4RH     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: Mary Blake     Date: 2 2 0 3 2 0 1 0 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 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 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Manor Road, 2 2 Manor Road Tynemouth North Shields Tyne & Wear NE30 4RH 01912574519 F/P01912574519 NoEmail Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kay Care Services Limited Name of registered manager (if applicable) Mrs Susan Anthea Baston Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, maximum number of places: 6. Old age, not faling within any other category Code OP, maximum number of places: 17 Date of last inspection Brief description of the care home The home provides personal care and accommodation for older people who require long-term care. The home is located in the village of Tynemouth close to shops, pubs, the post office and seafront. There are good transport links near-by. The home has a Care Homes for Older People Page 4 of 26 Over 65 0 17 6 0 Brief description of the care home passenger lift, and service users have access to a landscaped front garden and a paved courtyard. The majority of bedrooms have en-suite facilities, and communal areas are attractively furnished. Fees for the home vary and information is available directly from the home. Inspection reports and the service user guide are available in the home on request. Care Homes for Older People 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 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 quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. An unannounced visit was made on the 22nd March 2010. Before the visit we looked at information we have received since the last inspection, how the service dealt with any complaints and concerns and any changes to how the home is run. We looked at the providers view of how well they care for people, the views of people who use the service & their relatives, staff and other professionals, including surveys. The Annual Quality Assurance Assessment (AQAA), which is a self-assessment document, was sent to the home for their completion and was returned to CQC. Have your say questionnaires were sent out to people who have used or had interest in the Care Homes for Older People Page 6 of 26 home, seven of which were returned to us. During the visit we talked with people who use the service, relatives, staff and the manager, looked at information about the people who use the service and how well their needs are met, looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We also looked around the building/parts of the building to make sure it was clean, safe and comfortable and checked what improvements had been made since the last visit. We told the manager what we found. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 26 What the care home does well: Staff were friendly and relaxed with the inspector and were keen to discuss their work and the care needs of people who use the service. The home and staff create a positive atmosphere, which people commented upon and which is welcoming to families and visitors. The home has links with supporting health professionals, who give good health support to people who use the service. A good range of social activities takes place both within and outside of the home and this gives people who use the service the opportunity to meet, mix and socialise with others. The food provided is of a good standard, with good choice and variety. The dining room is well laid out with good staff attendance enabling people to have a pleasant and social mealtime. There is a complaints procedure and in addition the views of people who use the service are actively sought. They felt their views were listened to and acted upon. The home is furnished and decorated to a good standard and provides comfortable and pleasant surroundings for people who use the service. Individual bedrooms are well furnished and the communal areas are well decorated and used for a range of social events. The home is well staffed with a skilled, consistent and trained staff team giving security to people who use the service. The service gives good support to enable individuals to maintain and develop personal and family relationships. More than fifty percent of staff have undertaken National Vocational Training in Care at level Two or above and exceed the minimum standard, ensuring people who use the service receive care from a skilled and knowledgeable staff team. People who use the service and their relatives comments included I feel safe here everyone is lovely when they speak to me all the staff are so nice I feel warm and secure here I am very happy we were unanimous in our decision that Manor Road was excellent. Over the past two years we have had not reason to regret that decision due to the dedicated care of the manager and her staff Manor Road looks after my mam very well All the staff are very caring they see to all her needs They are very good to relatives as well we can talk to the manager anytime we want and she listens. People who use the service live in a home, which is well run and managed. Care Homes for Older People Page 8 of 26 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 Older People Page 9 of 26 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 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 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. Although people are able to visit the home before admission they would benefit from having their needs assessed prior to admission. Evidence: The home is currently partially occupied with only 18 residents (registered for 23). The manager stated that they are actively seeking admissions. We looked at the last admission documentation and discussed this with the manager. The pre-admission resident assessment was not completed, signed or dated and the subsequent care plan was incomplete. The manager stated that the resident had been privately funded and did not have a care management assessment. Their pre-admission assessment had not been fully completed and the subsequent care plan did not have sufficient detailed information. Other recent admissions were appropriately documented. Care Homes for Older People Page 11 of 26 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. People receive good care and support which takes into account their needs and promotes their privacy. The residents health, personal and social care needs are not set out fully in their individual plan of care. Evidence: We looked around the bedrooms and communal areas. The majority of residents were up and about. Some were in the lounge area and others were in their rooms. All of the residents looked very well, clean and comfortable. Three care plans were examined and case tracked. This means that we spoke to the individual residents or observed their care and then matched our observations to what was written in the care plan. We examined three sets of resident plans and found that the quality of recording was generally satisfactory however there were some areas that were incomplete. The recorded information was inconsistent. There was inadequate emphasis on residents strengths and abilities and what staff should do to maintain these and there was Care Homes for Older People Page 12 of 26 Evidence: limited involvement of the residents and their relatives. Nutritional risk assessments were in place and residents had nutritional care plans, but monthly nutritional risk assessment evaluations were not completed and in addition weight recordings were inconsistent. The individual health needs of people who use the service are identified and people are supported to access community health services such as doctor, district nurse, dentist, and optician. The care plans showed that people who use the service have access to all NHS services and facilities if required. A number of assessment tools are in use. Daily reporting of peoples care was good with any changing health care being reviewed but not always updated in the care plan. Staff ensure that personal support is flexible. The system for ordering, storage, administration and disposal of medication is well organised. Internal and external audits are undertaken. Staff undertake appropriate training and are competency assessed. Care Homes for Older People Page 13 of 26 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. There were sufficient activities to meet residents social needs. Residents are supported to receive a wholesome diet. Evidence: There was good evidence of social activities happening in the home. The residents had been involved in making easter bonnets and cards and these were displayed around the home. All staff are involved in supporting activities with residents ensuring it is an integral part of the residents day. Each individual has completed within their care plan their history and social needs assessment which outlines their interests and activities they have taken part in on a daily basis. Relatives and people who use the service felt that there was a good social activities programme both within and outside of the home and this was thoroughly enjoyed by all. Individuals have the choice to follow their spiritual beliefs and attend church services. Residents care plans had information on social interest but need to develop more Care Homes for Older People Page 14 of 26 Evidence: emphasis on residents strengths and abilities and what staff should do to maintain these. Arrangements for residents to maintain contact with their family and friends are well supported and families are encouraged to take residents out and about. Residents told us that they could have visitors at any reasonable time. We noticed visitors in the home coming and going freely. The meals served were good and people said they enjoyed the food, which was well cooked. Staff support was on hand. The tables were nicely set and lunch was seen as a social occasion. Hot and cold drinks were readily available. The cook is part of the staff team and was available to residents for comments and requests. They had good knowledge of the individual dietary needs of residents and of the nutritional needs of older people. Care Homes for Older People Page 15 of 26 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. There are procedures in place to make sure that complaints are dealt with satisfactorily and that residents are protected from harm. Staff had received training in the safeguarding of vulnerable adults and were able to use the whistle blowing procedures. Evidence: The complaints procedure is displayed in the home and available to each resident. Residents and relatives said that they knew problems were dealt with and how this would be done. No complaints had been investigated by the provider. There had been one complaint received by CQC since the previous inspection, this related to the lift not being operational, this was temporarily resolved. The manager stated that staff were aware of the whistle blowing policy and informing the manager of any incidents or issues of concern. Staff confirmed this during discussion and it was clear from training records which staff had received safeguarding of vulnerable adults training. The manager was aware of individual legal rights and how to protect them. Service users hadnt had the opportunity to vote but those interested knew that the manager would arrange it for them by visiting polling stations or postal vote. The manager was aware of the need to protect people who may not be able to make individual decisions, the mental capacity and deprivation of liberty legislations and their implications. Care Homes for Older People Page 16 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, 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 offers accommodation that is clean, comfortable and personalised. Evidence: The home is over three floors and provides care for a range of need. There are bedrooms, bathrooms, communal rooms on each floor. The ground floor is used for support services like the office, kitchen and laundry. The location and layout is suitable for the people who use the service. There are lounges and a dining room. These are pleasantly decorated and furnished. People who use the service were able to move freely around the communal areas and there was a range of television and audio equipment available for their use. Individuals are involved in personalising their own rooms. The rooms are of a good standard, some are en suite, well maintained and adapted to meet the wishes of the individual. People who use the service were very positive about the home. Maintenance contracts are in place and the building is generally well maintained. The passenger shaft lift has had long terms maintenance and issues with breakdowns, there are plans to replace this lift. There are aids and adaptations throughout. Care Homes for Older People Page 17 of 26 Evidence: The home was extremely clean. Care Homes for Older People Page 18 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 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. There are adequate numbers of care staff on duty to care for the residents. Staff training records are clear and the recruitment process in place protects residents. Evidence: The home is well staffed with a skilled, consistent and trained staff team giving security to people who use the service. Staff recruitment and training records were clear and concise and contained all relevant information. The vetting process helps protect people who use the service. The staff have a good understanding of the individual needs of people who use the service, who were very complimentary about the staff. Staff have undertaken National Vocational Training in Care (NVQ) at level two or above and additional training, ensuring people who use the service receive care from a skilled and knowledgeable staff team. Staff have continued to undertake training and spoke of using this knowledge in their practice. Three staff files were looked at and found to be organised and have clear evidence of individual training. Staff were clear there was a training programme in place for staff working at the home. Staff said they had completed training and were able to say on what and when this had taken place. Care Homes for Older People Page 19 of 26 Evidence: We were able to confirm which staff had undertaken national vocational qualifications. Three staff training and recruitment files were looked at across all grades. All of these were complete and contained sufficient information to indicate that residents were protected. Staff spoke knowledgeably about the individual needs of residents. In addition to the care staff domestic, maintenance and kitchen staff were on duty. Care Homes for Older People Page 20 of 26 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 has been managed well and the health, safety and welfare of residents and staff are protected. Evidence: The manager of the home has satisfactorily completed her registration as a manager and is only responsible for 2 Manor Road. The manager has introduced systems to enable residents, relatives, staff and supporting health professionals to voice their views. The people who use the service and staff made positive comment about the manager and staff team, they gave examples of good practices and of the staff team taking time to listen and respond to any concerns they may have. The provider has a quality assurance and audit system in place. The manager has an open and inclusive style that was commented upon by staff, Care Homes for Older People Page 21 of 26 Evidence: residents and relatives. She undertakes daily walkabout to talk to people who use the service, staff and visitor and has an open door policy. Monies are held on an individual basis, two signatures are obtained, receipts are kept, and the system is audited and accountable. Staff said they did not receive supervision and there were no records of supervisions, this was acknowledged by the manager. Review of accident records showed these were well documented with manager overview and action. There is evidence of risk assessment updates, the falls risk team are contacted and risk management strategies put in place. Records were organised, easy to access and up to date. Procedural policies available to staff in the office. Fire alarm and prevention testing had not always been undertaken at the recommended timescales. There were systems established for maintenance to be undertaken when necessary. Care Homes for Older People Page 22 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 Older People Page 23 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 1 3 14 To ensure that all 25/05/2010 preadmission documentation is completed. This will ensure that the home can meet the assessed needs of the resident. 2 7 15 Ensure that care plans are kept under review and where appropriate and, unless it is impracticable after consultation with the service user or his representative of his, revised to reflect service users changing health and welfare needs. This will ensure that service users and their representatives are fully aware and involved with the plan of their care 25/05/2010 3 8 13 Ensure residents are 25/04/2010 weighed, nutritional risk assessments are undertaken Page 24 of 26 Care Homes for Older People 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 and that fluid and nutritional records are kept for those at risk This will ensure that accurate records are kept of residents weights and nutritional and fluid intake. 4 19 13 Provide to CQC a programme of maintenance for the home to ensure that the home is maintained and safe at all times. This must address the outstanding work required to the passenger lift in a timely fashion. To ensure that residents live in an environment that is safe. 5 36 18 All staff must be appropriately supervised. This will improve the mangement of staff and help improve the quality of the service provided. 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 14/05/2010 25/06/2010 1 38 All fire prevention and detection equipment should be tested at the recommended timescales. Care Homes for Older People 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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