Care Home: Merseyview Residential Care Home

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What the care home does well Before a person moves into Merseyview an assessment of their care needs and lifestyle choices is carried out. This is to make sure the facilities of the home and knowledge and skills of the staff team can support them appropriately and safely. Services users spoken with during our visit made the following comments: "I only need a little help to have a bath the girls are good and don`t rush me". "The girls are very good and help me when I need it". The manager and the staff team work very hard to provide a person centred care service which looks at the individual needs and wishes of service users. Offering support to enable them to remain as independent as possible and to be the main contributor to decisions made about their daily lives. Service users spoken with and information received from completed surveys provided the following comments: "I like making things it keeps my mind active and my hands busy". "I would rather be in my own home but I`m not well enough living here is quite nice" " I like going out but need some help as I`m not steady on my feet the girls come with me when they have time". Records show service users are supported to access a range of healthcare services from GP and hospital to dental and chiropody appointments. This information was confirmed by service users spoken with during our visit: "If I feel unwell Julie or T will ask the doctor to call, I have been quite unwell recently and the staff have been very good looking after me". Service users spoken with felt they were listened to by the manager and the staff team and felt confident any concerns they may have would be dealt with. Service users spoken with and information received from completed surveys provided the following comments: "I would speak to Julie if I was worried or angry about anything" "The girls are very good if I was unhappy about anything I would talk to them or Julie". "Julie is here all the time she always asks if everything is OK or if I am worried about anything". Service users spoken with felt the staff team and manager respect them and their individual choices making them feel valued and respected. Service users spoken with and information received from completed surveys provided the following comments:"The girls are lovely and very helpful". "They make my daughters and the rest of my family feel very welcome that is important to me". "This is my home now and they are like my family". "They help me when I need it and respect that I like to spend time on my own, they don`t make me go to the lounge or dining room". The service has a robust recruitment process ensuring all necessary safety checks are made prior to an offer of employment being made. This offers service users protection from being supported by people who should not work within the care sector. What has improved since the last inspection? The manager and deputy manager have worked hard to improve the care planning and risk assessment systems used. This has included reorganising files to make it easier to access information, working with service users and their families to gain more information about their life experiences. Enabling them to target activities and social event to reflect their interests and hobbies. Information recorded in service users daily records is more detailed and links to information held in care plans making it easier to review care and support being provided. Ensuring that service users receive appropriate and safe care and are supported to maintain their independence. Information recorded about service users health care needs has improved with greater detail recorded about outcomes from hospital consultations or GP visits. This enables the staff team to respond effectively to changes in service users health and emotional wellbeing. What the care home could do better: Out of date information in service users care files that does not reflect the care, emotional or social needs of service users should be archived. As it could prove confusing for the staff team and lead to inappropriate care and support being offered. The manager needs to review the home quality assurance systems to make sure they are robust and seek the views of all people involved with Merseyview including service users, their families, friends, health and social care professional. This will help the service develop and give them confidence the services and facilities provided are meeting service users needs, expectations and lifestyle choices. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Merseyview Residential Care Home 12 Penkett Road Wallasey Wirral CH45 7QN     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: Helen Carton     Date: 1 6 0 3 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Merseyview Residential Care Home 12 Penkett Road Wallasey Wirral CH45 7QN 01516306277 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Julie O`Rourke Name of registered manager (if applicable) Julie O`Rourke Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only: Care home only - Code PC, to people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of people who can be accommodated is 12. Date of last inspection Brief description of the care home Merseyview is a large semi detached Victorian property in Wallasey close to New Brighton promenade and local transport links to Liscard, Birkenhead and Liverpool. The owner/manager is registered to offer support to 12 older people, both men and women. There are twelve single bedrooms five of which have toilet en-suite facilities. There is a large lounge and separate dining room that looks out over an extensive well maintained garden. Care Homes for Older People Page 4 of 29 care home 12 Over 65 12 0 Brief description of the care home There is off road car parking facilities at the front of the building. Currently the accommodation fee to live at Merseyview is 360 pounds per week. A copy of the most recent inspection report is available with the homes statement of pupose and service user from the manager. Care Homes for Older People Page 5 of 29 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: As part of the inspection process we sent Merseyview an Annual Quality Assurance Assessment (AQAA) document, which was completed prior to our visit to the home. This document was to provide information about the service at Merseyview and to tell us where they felt they had made improvements to the way they support service users and the staff team. As part of the inspection process surveys were sent to five service users and three members of the staff team, a total of six responses were received. The last inspection on this service was completed on 20/02/08 Care Homes for Older People Page 6 of 29 We visited Merseyview to enable us to look at records and to discuss how the home supports service users in all aspects of their lives. Part of this process involved speaking with the manager, members of the staff team and spending time with service users to find out their views on living at the home. We spent approximately seven hours at Merseyview. What the care home does well: Before a person moves into Merseyview an assessment of their care needs and lifestyle choices is carried out. This is to make sure the facilities of the home and knowledge and skills of the staff team can support them appropriately and safely. Services users spoken with during our visit made the following comments: I only need a little help to have a bath the girls are good and dont rush me. The girls are very good and help me when I need it. The manager and the staff team work very hard to provide a person centred care service which looks at the individual needs and wishes of service users. Offering support to enable them to remain as independent as possible and to be the main contributor to decisions made about their daily lives. Service users spoken with and information received from completed surveys provided the following comments: I like making things it keeps my mind active and my hands busy. I would rather be in my own home but Im not well enough living here is quite nice I like going out but need some help as Im not steady on my feet the girls come with me when they have time. Records show service users are supported to access a range of healthcare services from GP and hospital to dental and chiropody appointments. This information was confirmed by service users spoken with during our visit: If I feel unwell Julie or T will ask the doctor to call, I have been quite unwell recently and the staff have been very good looking after me. Service users spoken with felt they were listened to by the manager and the staff team and felt confident any concerns they may have would be dealt with. Service users spoken with and information received from completed surveys provided the following comments: I would speak to Julie if I was worried or angry about anything The girls are very good if I was unhappy about anything I would talk to them or Julie. Julie is here all the time she always asks if everything is OK or if I am worried about anything. Service users spoken with felt the staff team and manager respect them and their individual choices making them feel valued and respected. Service users spoken with and information received from completed surveys provided the following comments: Care Homes for Older People Page 8 of 29 The girls are lovely and very helpful. They make my daughters and the rest of my family feel very welcome that is important to me. This is my home now and they are like my family. They help me when I need it and respect that I like to spend time on my own, they dont make me go to the lounge or dining room. The service has a robust recruitment process ensuring all necessary safety checks are made prior to an offer of employment being made. This offers service users protection from being supported by people who should not work within the care sector. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 9 of 29 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 10 of 29 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 11 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users can be confident the home can meet their identified care needs and personal aspirations in a safe and supportive environment Evidence: The statement of purpose and service user guide are currently being updated to reflect the improvements being made to the homes environment and the exterior of the building as the registered provider is in the middle of a redecoration and refurbishment programme. Before a person moves in to Merseyview the manager or her deputy makes arrangements to carry out a full assessment of the persons needs and lifestyle choices. The assessment process involves talking and spending time with the person who wishes to move into the home and talking to their relatives and other professionals involved in their care. Admissions to the home only take place if the Care Homes for Older People Page 12 of 29 Evidence: manager or deputy are confident they can meet the prospective service users identified needs. This approach ensures service users can be confident they are moving into a home that can meet their physical, emotional and psychological needs. Care Homes for Older People Page 13 of 29 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. Service users personal and health care needs are met by a staff team who are skilled, respectful and sensitive to their needs. This results in them receiving a person centred service which respects and promotes their individual needs and aspirations. Evidence: Service users receive personal and health care support using a person centred approach with support provided being based upon the rights of service users to be treated with dignity, equality and respect. This ensures service users receive individualised care and support based on their needs and lifestyle choices. Care plans provide a comprehensive overview of service users health, social, emotional and psychological needs. These plans are regularly reviewed to ensure the care support provided meets the changing needs and wishes of service users. Enabling service users to have confidence that the home can continue to meet their needs in a sensitive and professional manner. The manager was advised to review the amount of historical information held in care files as this could be confusing or misleading to the Care Homes for Older People Page 14 of 29 Evidence: staff team. Service users spoken with provided the following information: I only need a little help to have a bath the girls are good and dont rush me. The girls are very good and help me when I need it. Records show service users are supported to access health care services when required including GP, hospital, podiatry, district nurse services and optical services. This information was confirmed by service users spoken with during the visit and in completed surveys sent to us. We looked at a number of risk assessments and discussed with the manager the need to review them more frequently this is to ensure issues of concern are identified early and additional support or equipment is accessed to support service users to remain as independent as possible. The manager told us she carries out reviews as soon as an issue of concern is identified. If I feel unwell Julie or T will ask the doctor to call, I have been quite unwell recently and the staff have been very good looking after me. The home has an efficient medication policy and a procedure that is clear and easily understood for the staff team to follow. Medication records are fully completed and signed by members of the staff team trained to administer medication. This ensures service users receive their medication at the correct intervals and dosages to support them to maintain their physical and mental wellbeing. The AQAA document tells us service users have access to a public telephone in the entrance hall, however they are also supported to have a telephone line fitted in their bedrooms for easy access and privacy. This information was confirmed by service users spoken with during our visit to the home. Service users spoken with felt their relatives and friends are made to feel welcome when they visit. We observed members of the staff team supporting service users in a respectful and affectionate manner. Care Homes for Older People Page 15 of 29 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. Service users views and wishes are valued and form the basis of social and leisure activities provided by the home. Resulting in positive outcomes for service users to enable them to maintain their emotional and mental well-being. Evidence: The manager and the staff team support service users to develop friendships within the home and to maintain important personal and family relationships. Enabling service users to remain connected to their lives prior to moving into Merseyview. I have the phone in my room which I like as it helps me keep in touch with my family. Service users are supported to continue to take part in activities they enjoyed doing prior to moving into the home and to become part of the home community through shared activities and experiences. This supports service users to be involved in meaningful activities and to engage in decision making regarding how they spend their days. Service users spoken with and comments made in returned surveys provided the following information: Care Homes for Older People Page 16 of 29 Evidence: I like making things it keep my mind active and my hands busy. I would rather be in my own home but Im not well enough living here is quite nice I like going out but need some help as Im not steady on my feet the girls come with me when they have time. The dining room has seating for twelve, service users are encouraged to eat their meals together however if they wish to have their meals in their bedrooms they are supported to do so. The dining room is nicely decorated and furnished with views over the garden. Service users spoken with and comments made in returned surveys provided the following information: They will change any food I do not like. They are happy to serve me in my room if I want I really like the food and there is plenty of it If I dont want the meal on offer they will always make me something else. I like to nip into the kitchen to check what we are having it makes it feel like home. Care Homes for Older People Page 17 of 29 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. Service users views and opinions are sought and acted upon. This results in a service that proactivelly promotes service users rights as citizens to be protected from discrimination and abuse. Evidence: The home has an open culture that allows service users to express their views and concerns in a safe and understanding environment, resulting in service users feeling valued and respected. Service users spoken with told us they are happy with the level of service provided, feel safe and supported by the manager and the staff team who promote their protection and safety. Service users spoken with provided the following comments: I would speak to Julie if I was worried or angry about anything The girls are very good if I was unhappy about anything I would talk to them or Julie. Julie is here all the time she always asks if everything is OK or if I am worried about anything. Care Homes for Older People Page 18 of 29 Evidence: All members of the staff team have received safeguarding adults training with refresher training taking place at regular intervals. Members of the staff team spoken with demonstrated a good understanding of their roles and responsibilities regarding protecting service users from all forms of abuse and neglect. Resulting in service users living in an environment which respects and supports their lifestyle choices and promotes their wellbeing. Care Homes for Older People Page 19 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current environment adequately meets the needs of service users and offers them a homely and comfortable place to live. Evidence: Merseyview provides a comfortable environment for service users to live in and there is a programme in place to redecorate and refurbish all areas of the home. Service users are supported to personalise their rooms and to have a say in how areas of the home are decorated. Since our last visit to the home a new kitchen and appliances has been fitted, four bedrooms have been redecorated and refurbished, the entrance hall and the dining room have also been redecorated. However some of the windows are in a poor state of repair and need to be replaced. The manager acknowledges this and told us the large bay windows to the front of the building would be replaced in the summer. Service users spoken with told us they felt comfortable living at Merseyview and had no complaints about the facilities provided. All areas of the visited were clean and tidy. Care Homes for Older People Page 20 of 29 Care Homes for Older People Page 21 of 29 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. Service users are supported by a well trained and skilled workforce resulting in their individual needs and lifestyle choices being met in a person centred way. Evidence: Rotas show Merseyview is staffed efficiently and in a way that supports service users daily routines enabling them to feel in control. Service users spoken with during the visit provided the following comments: The girls are lovely and very helpful. They make my daughters and the rest of my family feel very welcome that is important to me. This is my home now and they are like my family. They help me when I need it and respect that I like to spend time on my own, they dont make me go to the lounge or dining room. The manager supports the staff team to undertake training courses to enable them to Care Homes for Older People Page 22 of 29 Evidence: gain the skills, knowledge and expertise to support service users needs and lifestyle choices effectively and safely. Members of the staff team spoken with and comments made in returned surveys provided the following information: Merseyview has improved greatly, the decorating, cleaning and food is the best As I have worked in the same place for nearly 10 years I think that speaks for itself. The care given to the residents is to a high standard and they look happy. Julie is very supportive and fair. We do a lot more training now I enjoy it. We all get on well and help each other Merseyview has a robust recruitment procedure and carries out all the required safety checks as part of the process of protecting service users from harm. Staff files were well maintained with all the required information clearly documented. Care Homes for Older People Page 23 of 29 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 management and administration systems within the home promote the health, safety and welfare of service users. Evidence: The registered manager, Mrs Julie ORourke has approximately 20 years experience working in the care sector ten of which have been as owner/ manager of Merseyview. There are management systems in place to support the running of the home including policies and procedures and clear financial planning with a commitment to continuously improve services. Leading to an increased quality of life for service users with a focus on promoting equality, dignity, respect and fairness. The manager is open and transparent and is supportive of both service users and the staff team. Care Homes for Older People Page 24 of 29 Evidence: The home works to a clear health and safety policy, with the staff team being supported to undertake training at regular intervals. Regular supervision takes place including observational supervision to ensure staff members adhere to health and safety procedures. The home does not hold or manage service users finance other than the collection of accommodation charges from the either placing authority or service users legal representatives or family members. However facilities and systems are in place if the need to hold monies for service users arises. A selection of health and safety records were examined they demonstrated the manager and the staff team work hard to ensure service users live in a safe and healthy environment. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 19 23 Damaged windows must be repaired or replaced. This is to ensure service users live in an environment that is well maintained and safe. 01/09/2009 2 24 23 Damaged decoration or furnishings in bedrooms must be repaired, redecorated and replaced. This is to ensure service users live in a comfortable and pleasant environment. 31/12/2009 3 33 24 Robust quality assurance systems must be implemented in the service. This is to ensure service users and the management team can be confident the services being provided are effective and meet the needs and aspirations of service users. 20/07/2009 Care Homes for Older People Page 27 of 29 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 1 The statement of purpose and service user guide should be updated to accurately reflect the services and facilities provided by Merseyview. Historical information that does not reflect current care needs held in care files should be archived. This is to ensure the staff team are confident the information they refer to is current and meaningful with regard to the care and support they are providing. Risk assessments should be routinely reviewed at regular intervals.This is to ensure service users, members of the staff team and where appropriate relatives and carers can raise their concerns about their wellbeing. As part of the maintenance programme worn and damaged carpets should be replaced. The manager should continue to work toward gaining the NVQ level 4 Managers Award. 2 7 3 8 4 5 19 31 Care Homes for Older People Page 28 of 29 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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