Care Home: Middle West

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What the care home does well The home supports people to lead busy lives and take part in the activities that they enjoy. All care plans are reviewed regularly and kept up to date to ensure that people have their needs met. Everyone that uses the service is very happy with the support they are receiving. The manager has a good understanding of each persons needs and spends time working alongside staff to ensure they are competent in carrying out their roles. People that use the service have been given the information they need in order to make a complaint about the service if they need to. The manager has spent time ensuring that people understand the complaints procedure and their care plans. What has improved since the last inspection? Since the last inspection the registered provider has ensured that all documents relating to service users are kept in the home and that the manager has access to them. This meets the requirement that was made in the last report. The registered provider has shared information with all staff in relation to the Mental Capacity Act. What the care home could do better: The registered manager should ensure she has a full understanding of all areas of running the home. It would benefit service users if staff and the manager were to complete training in person centred planning and use this to support people to take control of their own lives. Any restrictions in a persons life must be clearly documented, with the reasons for this, in the care plan. It is recommended that all service users have a health action plan and be supported to develop their skills to manage their own medication as far as possible. Service users would benefit from more staff undertaking the NVQ award. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Middle West Middle West Carlton Road South Godstone Surrey RH9 8LE     The quality rating for this care home is:   three star excellent 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: Jo Griffiths     Date: 1 4 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 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 Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Middle West Carlton Road Middle West South Godstone Surrey RH9 8LE 01342893804 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : j.esparon@btconnect.com Mr Jonathan Georges Esparon,Mrs Winifred May Esparon care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 10 The maximum number of service users who can 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 Date of last inspection Brief description of the care home Middle West is a care home registered for provision of personal care and support for ten adults with learning disabilities. The building is a detached chalet bungalow, with two bedrooms and a bathroom on the first floor and the remainder of bedrooms and a further three bathrooms on the ground floor. The location of the home is semi-rural within a private residential estate. Transport is provided by the home to facilitate access to nearby South Godstone village and all community facilities. Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home Communal areas are spacious with a comfortable lounge, dining room, kitchen and large conservatory. A separate utility room and office facilities are located at the rear of the home. A wheelchair accessible shower room is available on the ground floor additional to other bathing facilities. Bedroom accommodation is a combination of single and shared occupancy rooms although there is currently no one sharing a bedroom. One of the shared bedrooms on the ground floor has an en-suite bathroom. The first floor shared bedroom, single bedroom and bathroom are accessible by a steep, narrow staircase and therefore are not suitable for people with mobility difficulties. The home has a garden to the side with a patio area and car parking facilities. The fees charged range from £822 to £1400 per week depending on individual needs. Care Homes for Adults (18-65 years) Page 5 of 28 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: three star excellent 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 was a key inspection of Middle West care home. It included a review of information received about the service since the last key inspection, a review of the Annual Quality Assurance Assessment completed by the provider and a visit to the service. Surveys were also sent to four people that use the service to gather their views. At the visit to the home the registered manager was present. Some of the records and documents were inspected and the inspector had a look around the home and spoke with three service users. Care Homes for Adults (18-65 years) Page 6 of 28 Care Homes for Adults (18-65 years) Page 7 of 28 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they need to make a decision about using the service. People moving to the home have an assessment of their needs and are assured these will be met before they are offered a place at the home. Evidence: People in the home are given a copy of the Service User Guide when they move into the home. This is presented in a user friendly format with pictures and clear language. Three people that use the service showed the inspector their copy of the service user guide that they keep in their room. There is also a Statement of Purpose for the service that gives more detailed information about the services provided and the structure of the home. The manager described the assessment process for people moving into the home. The assessment of need was seen for two people and this covered all areas of support that Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: they may need. The assessments had been updated as part of the care plan review. Two people that use the service told the inspector that they felt their needs were being met and that they are getting the support they need. The feedback in the service users surveys also confirmed this. Care Homes for Adults (18-65 years) Page 11 of 28 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 have an individual plan that meets their assessed needs. They are supported to make some decisions in their lives and to have a say in how the home is run. People using the service are supported to take assessed and reasonable risks as part of an independent lifestyle. Evidence: Each person has an individual plan. Two of these plans were inspected and these showed that the individual had been consulted on the content and had signed the plan. None of the staff have undertaken training in person centred planning and whilst it is clear that the plans have been discussed with service users, they would benefit from staff using person centred planning to help them take more control and ownership of their plans. Person centred planning should also be used to support people to make wider decisions in their lives, for example, where they wish to live and future hopes and Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: dreams. People using the service have a copy of their plan in their bedrooms and they were able to show the inspector where this is. To further improve the plans consideration should be given to using pictures and symbols, as part of person centred planning, to help people write their own plans. Risk assessments have been completed as part of the individual plans. Within the two plans inspected these showed the risk assessments were relevant to their needs and had been kept under review. However, the manager told the inspector that one person requires restrictions in the use of computer games and ipod due to health reasons and there was not a risk assessment in place detailing this restriction and the reasons why. The manager and registered provider manage individuals personal monies and hold them for safe keeping. People are supported to use their own money when out to encourage them to develop monetary skills. Some people are also being supported to undertake money skills training. The records for individuals personal monies are complex, but when scrutinised it was clear that all monies were accounted for and receipts retained. From discussion with service users and from feedback in the surveys it was evident that they are offered choices in their everyday lives and are involved in the running of the home. This includes planning the weekly menu, interviewing new staff and choosing the decor of the home. One person stated in the survey We get choices and if we want something we always get it. Care Homes for Adults (18-65 years) Page 13 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead busy and interesting lives that meet their social needs. They have the support they need to access the community and to participate in leisure activities. People using the service are supported to undertake their responsibilities in the home and their rights to privacy and personal space are respected. A varied and nutritious menu is available and people using the service are supported to choose their meals. Everyone in the home enjoys the meals provided. Evidence: Each person using the service has a programme of activities designed to meet their social needs. This includes a range of activities at home and within the community. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Activities include, cookery course, day centre, music sessions, aromatherapy and massage, walks, lunch out, shopping and day trips to places of interest. When at home people can choose to spend time in their own rooms or one of the lounge/dining areas. There are books, games and crafts available, satellite TV and music centre. In the summer people said they enjoy using the patio area in the garden. The records in the home showed that the activity plans are followed and discussion with service users and feedback from the surveys also confirmed this. People said they enjoy the activities they are doing and that they have a choice about how they spend their time. Everyone is supported to make a choice daily about how they spend their time and everyone has the opportunity to go out regularly for activities in the local community. People are supported to maintain contact with their family, friends and, for some, their advocate. The individual plans identify the support that will be given to ensure they have the opportunity to maintain these relationships and to build new ones. Further work should be done with service users, through person centred planning, to help them identify their wishes with regard to personal relationships and their future hopes regarding this. The service users spoken with confirmed that they help with cooking and preparing their meals and get involved with some household tasks. Their privacy in their own bedrooms is respected and they have a locked space to keep their personal belongings. The registered person should ensure that all service users are offered a front door key and a key to their bedroom. The manager said that people are encouraged to answer the front door and telephone, but that staff could do more to promote this. By encouraging this further service users will be able to develop their independence and also a sense of it being their own home. The menu is planned weekly with service users and each person is supported to make their own evening meal. Records are kept of the meals provided and the choices that people make. Feedback from service users confirmed that they enjoy the meals and feel they have sufficient choice. Snacks, drinks and fruit are available for people to access when they want it. Some people can do this independently and others require staff support. Care Homes for Adults (18-65 years) Page 15 of 28 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 using the service have their personal care needs met in the way they prefer and are supported to be as self managing as possible. They have their health needs met through the primary care team and have their medication managed safely. Evidence: Individuals personal care needs are outlined in their individual plan and they are encouraged to be as self managing as possible. Staff only provide personal care to service users following an induction to the home and training. This involves working alongside the manager for a period of one week to ensure staff understand the care plans and individuals preferences when it comes to their care. People are supported to dress in the way that promotes their self esteem and expresses their identity. They are supported to wear, as appropriate, make up and jewellery and to purchase their own clothes. Service users health needs are documented in the individual plan along with a record of any involvement of health care professionals. It is recommended that Health Action Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Plans be introduced for each person as recommended in the Valuing People white paper. This will support people to identify their health needs in a holistic way and give them more control over managing their health. The health records showed that appointments are made for service users for health checks as required. One of the service users is currently signing for their medication under staff supervision and staff are working with a further three people in this area. The registered person stated that the care plans will be updated to reflect this. All medication is stored securely in the home. Staff records showed that they have completed training and that their competence to administer medication is assessed regularly through supervision sessions with the manager and registered provider. Care Homes for Adults (18-65 years) Page 17 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service know how to make a complaint if they need to and can be assured that their concerns will be taken seriously. They are safeguarded in the home from harm and abuse. Evidence: The home has a clear complaints procedure and a copy has been given to all service users. Three people showed the inspector the copy they keep in their room and were able to say how they would raise a complaint if they had one. Feedback generally from conversation with service users and from the surveys evidenced that they understood their right to make a complaint and felt that they would be listened to and taken seriously. One person said they would contact their care manager or the Care Quality Commission if they had any serious concerns. For people that have difficulty communicating an advocate or their relative can make a complaint on their behalf. The complaints procedure is made available to all relatives and advocates and the manager speaks regularly with service users, relatives and advocates to ensure they are happy with the service they are receiving. There have been no complaints received by the home or by the Commission since the last inspection. A number of letters of compliment have been received and service user feedback is very positive about the home. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Staff are trained in safeguarding adults and the reporting procedures they need to follow in the event of any allegation being made. The training is provided in house and a workbook is completed by the staff member to show their competence and understanding. It is recommended that the manager and staff attend training with an external provider, where possible, in safeguarding adults to ensure they have access to the most recent information about the local authorities reporting procedures. Staff are only employed in the home following a Criminal Records Bureau Check, including a check against the vulnerable adults register, and references being taken up by the registered person. Staff files were inspected and these showed that the required checks had been made prior to staff starting work in the home. The service users spoken with confirmed they feel safe in the home and that they know their rights to report any concerns. Care Homes for Adults (18-65 years) Page 19 of 28 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 home is clean, comfortable and safe and meets the needs and preferences of the people that live there. Evidence: The home is kept clean and is maintained to a high standard of decor and repair. There are some shared bedrooms and some single bedrooms, although currently all rooms are being used as single bedrooms. The manager stated that there are plans to convert all bedrooms to single rooms and is aware of the need to only accommodate people in shared bedrooms if it can be evidenced that they have chosen this themselves. There is a large lounge, a dining room and a large conservatory for people to use and the kitchen is accessible to the people living in the home. There are sufficient bathrooms to meet people needs with a mixture of baths and showers and since the last inspection the bathrooms on the ground floor have been refurbished. Some of the bedrooms have ensuite facilities. Three people showed the inspector their bedrooms and they said they had everything they needed and are happy with their rooms. Care Homes for Adults (18-65 years) Page 20 of 28 Care Homes for Adults (18-65 years) Page 21 of 28 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. People using the service are supported by trained staff, but would benefit from more staff completing a relevant care qualification. They are safeguarded by the services procedures for recruiting new staff. People using the service are assured that the staff are properly supervised in their work. Evidence: Three staff files were seen and these contained documentation to evidence that appropriate checks had been made before employing people in the home. This includes two written references, health check and a criminal records check. All staff complete an application form, stating their job history, and undergo an interview. The manager said that service users are sometimes involved in interviewing new staff. The staff files also showed that all staff have completed the training they need to carry out their roles safely and to meet the specific care needs of service users. However, as recommended earlier in this report, it would be beneficial to service users if staff were to undertake training in person centred planning and use these skills when supporting people to make decisions in their lives. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Only one member of staff has an NVQ. Some of the staff have trained as nurses overseas, but have not completed any relevant qualifications in the UK as yet. All staff should be encouraged to complete the NVQ award and as a minimum 50 of staff should hold the qualification. Staff have regular supervision with the registered person and the manager and the records showed that this covers many areas of their work and practice. The supervision sessions are also used as a means of keeping staff updated with any changes in legislation and good practice guidance. Care Homes for Adults (18-65 years) Page 23 of 28 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. Service users benefit from a competent and experienced manager, although would benefit further from the manager having more control and understanding of the running of the home. The service is run in the best interests of its users and people are always consulted on their views of the care they receive. The health and welfare of service users and staff is protected. Evidence: The manager has worked with the service user group for many years and demonstrates an excellent understanding of their individual needs. Service users spoken with said they like the manager and feel they can talk to her or the other staff if they have any concerns. The inspector discussed with the manager the benefits of keeping up to date with the latest government policies relating to people with learning disabilities, for example the recent update to Valuing people called Valuing people Now. The manager Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: demonstrated an understanding of what person centred planning is but would benefit from training in this area to ensure that person centred approaches are fully embedded in service delivery. The manager said that the registered provider completes most of the paperwork for the home, including the care plans, and manages the staff training and house budgets. The registered manager must ensure that she has a full understanding of all matters relating to the running of the home, and control of such matters, in order to effectively fulfil the registered managers role. however, at the time of the inspection the manager demonstrated that she is effectively running the home, on a day to day basis, and that she has the best interest of the service users at the core of service delivery. Quality assurance surveys are sent out to service users, relatives and health care professionals annually. The most recent surveys were completed in February 2009 and showed that people are happy with the service they receive. Where one comment was made about staff knowledge of a persons needs this has been addressed by the registered provider through supervision. It is noted that people are supported to complete surveys by staff in the home and it is recommended that, where possible, people be given any support they need by an independent person. Relevant risk assessments have been completed for the home and a fire risk assessment is in place, although it was noted this is due to be reviewed. There were no matters of health and safety concern in the home. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 6 12 The registered person must 19/06/2009 ensure that any restrictions on a service users freedom and choice are recorded in the care plan, along with the reasons for such as restriction and who has been involved in making the decision. The restriction must be reviewed regularly. To ensure that individuals rights are promoted. 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 27 of 28 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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