Care Home: North Shore Care Home

What the care home does well We found the home provides care in a flexible way, so that people have the opportunity to live their daily lives as they choose to. Comments included, "we are very flexible in the way we work and this benefits the residents, as people with dementia need that time". " We know the residents well and we know how to respond to their needs, they are all different". The way we saw staff speak and deal with people told us they do it with sensitivity. We saw they have the time to spend with people making sure their needs are being met, so that they are comfortable. We talked to the staff team on duty who confirmed they have a good knowledge of the individual care needs, social and cultural needs of people living at the home so that they are not disadvantaged in any way. Comments included, "All there needs are different but we get to know that from the care plans and what families tell us". The way the home manages its staff team told us they are supported by a management team who make them feel valued. Comments included, "I feel really supported and can raise issues with them if I have to". What has improved since the last inspection? There is now a manager registered with the Care Quality Commission, who is in day to day control of the home. The staff told us they feel supported by the manager who showed they have the knowledge and skills to carry out their role. Where possible the home endeavors to gain assessment information from placing authorities or from hospital discharge teams so that the home has the underpinning knowledge of a persons needs prior to or at the time of admission to the home. However, in all instances the home carries out its own assessment of need to ensure the home can meet that persons needs. By looking at care planning records we found there has been improvement in meeting the health needs of people living at the home. There is a clear record of how peoples health needs are being met and who is involved. We found there has been improvement in how activities are provided to people living in the home. There is an activity programme in place and due to an increase in staffing levels staff have more time to spend with people. We found all staff have access to training for safeguarding people. All staff have attended this training or on going to attend this training for the protection of people living at the home. Since the previous inspection we found there has been an increase in staffing levels meaning more staff are on duty at any time of the day, for the benefit of people living at the home. We saw all staff have a supervision plan in place and this is being used by the managerto support individual staff. What the care home could do better: We found that whilst the home has more time to spend on activities, there is limited evidence of activities designed specifically for people with dementia type conditions. Development of such activities would enhance the range of stimulation people living there experience. We saw there is a review of training for staff working in the home and this should continue so that the staff team are equipped with the knowledge and skills required to meet the individual needs of the people living there. Inspecting for better lives Key inspection report Care homes for older people Name: Address: North Shore Care Home North Shore Care Home 3 St. Stephens Avenue North Shore Blackpool Lancashire FY2 9RG     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: Jacqueline Riley     Date: 0 9 0 6 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 27 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 27 Information about the care home Name of care home: Address: North Shore Care Home 3 St. Stephens Avenue North Shore Care Home North Shore Blackpool Lancashire FY2 9RG 01253351824 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) : st_stephens@btconnect.com Mrs Brenda Christine Bell,Mr Keith Bell care home 25 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 25 The registered person may provide the following category of service only: Care home with nursing - Code N 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 The maximum number of service users who can be accommodated is: 25 Date of last inspection Brief description of the care home North Shore care home with nursing is an establishment providing residential and nursing care for up to 25 residents, who suffer from dementia. The home is situated in a residential area of Blackpool. There are three floors and a rear extension. There are twenty-three single rooms of which sixteen are en-suite. The home is equipped with an appropriate range of aids and adaptations suitable to meet the needs of residents living at the care home. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owners and staff and Care Homes for Older People Page 4 of 27 Brief description of the care home the services residents can expect if they choose to live at the home. A copy of the Service User Guide and most recent inspection report is issued to all prospective residents and their relatives/representatives to help them make an informed choice whether to move into the home, however it should be noted that due to the level of understanding of most residents due to dementia, most of the information is used by relatives or advocates of the resident. At the time of the inspection the fees were £364.61 to £583.68 per week. Care Homes for Older People Page 5 of 27 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: A key inspection of the home was undertaken which included an unannounced visit to the service on the 9th June 2009 and lasted approximately 5 hours. We spoke to the general manager, registered manager and five staff members. We also spoke to some people living there however due to their level of understanding they were unable to make comments. We did spend time in the lounge areas and made observations of how people communicated and moved around as well as looking at how the staff team responded to people who live there. The care records and other records relating to the care people receive were looked at. We also looked around the home with the general manager and spent time talking to people living there. As part of the inspection process we looked at the rooms some people occupy as well Care Homes for Older People Page 6 of 27 as looking at daily notes this is called case tracking. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide, and to make an assessment of the quality of their service. This document is called Annual Quality Assurance Assessment(AQAA). We use this information, in part, to focus our inspection activity. On 29th July 2008 we carried out an Annual Service Review of the home (ASR). This review is based upon information the home has provided us with in an Annual Quality Assessment (aqaa), as well as using information we have received since the previous inspection of the home including surveys. The report confirmed the home was still providing a good service to people living there. What the care home does well: What has improved since the last inspection? There is now a manager registered with the Care Quality Commission, who is in day to day control of the home. The staff told us they feel supported by the manager who showed they have the knowledge and skills to carry out their role. Where possible the home endeavors to gain assessment information from placing authorities or from hospital discharge teams so that the home has the underpinning knowledge of a persons needs prior to or at the time of admission to the home. However, in all instances the home carries out its own assessment of need to ensure the home can meet that persons needs. By looking at care planning records we found there has been improvement in meeting the health needs of people living at the home. There is a clear record of how peoples health needs are being met and who is involved. We found there has been improvement in how activities are provided to people living in the home. There is an activity programme in place and due to an increase in staffing levels staff have more time to spend with people. We found all staff have access to training for safeguarding people. All staff have attended this training or on going to attend this training for the protection of people living at the home. Since the previous inspection we found there has been an increase in staffing levels meaning more staff are on duty at any time of the day, for the benefit of people living at the home. We saw all staff have a supervision plan in place and this is being used by the manager Care Homes for Older People Page 8 of 27 to support individual staff. 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 Older People Page 9 of 27 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 27 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. There is admission and assessment procedures in place to ensure the care needs of people are met. Evidence: We looked at the records of three people living at the home. We saw the the most recent admission had assessment details in place from the health authority. Two other plans we looked at had been resident at the home for some time and whilst there was no placing authority assessment the home had undertaken a comprehensive pre admission assessment gaining as much information about the persons needs as possible so they know what those needs are at the point of admission. We were told that prior to an admission, the home endeavors to gain the assessment details from the placing authority, however in some instances this takes some time and therefore they use their own assessment format so the information is there for the staff team. The information seen in the assessment was comprehensive and included reference to Care Homes for Older People Page 11 of 27 Evidence: all areas of the persons needs and what the home should do to meet those needs. Comments received said, We usually get all the information we need when somebody is admitted so we have an outline of what their needs are, It can be difficult to get the information sometimes but we always carry out our own assessment of need anyway. We saw the homes information booklet is being reviewed and will shortly be published and distributed to users of the service so they know the details of the services the home is providing. Care Homes for Older People Page 12 of 27 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. Promotion of health is taken seriously. Residents welfare is monitored and their health needs are identified and met. Evidence: The three care planning records we looked at were accurate and up to date. There was good information about individual healthcare needs as well as how those needs are going to be met. Staff we spoke to said the information is clear and they can follow the plans to maintain and support people who live in the home. Comments included, we now have a key worker system and so we are involved in writing things about them in care plans, The care plans tell us all about the residents needs, and they are easy to follow as the information is always being updated. The records we looked at show there are risk assessments in place for people in all areas of their care, which highlight what the risk is, how it can be managed and what the outcome is for the person. There was evidence of risk assessments and care plans being reviewed on a monthly basis by the manager. In some instances there was Care Homes for Older People Page 13 of 27 Evidence: evidence of changes being made, so that staff are able to meet the presenting needs of the person at any given time. Care staff involved in the review process and those spoken to recognised the importance of review due to the changes in dependency. Comments included, people needs change all the time and we recognise this by doing regular reviews. By looking closely at the records we found there are links between the home and other healthcare professionals including, doctors, district nurses, and psychologists, so that a persons healthcare and psychological needs are being met. Medication records and observation of practices in administration showed us it is safe. Only trained nursing staff or the manager administers medication. We looked at three records and found them to be complete and up to date. We looked at how the home stores medication and found it to be in a locked purposeful facility, with metal locked cupboards bolted to the wall of a dedicated medication room to ensure the security of medication. We saw peoples privacy and dignity is respected during the visit by looking at how staff talk to and respond to residents. We found staff to be respectful and sensitive to individual needs throughout the inspection. We spent time in the lounge area and whilst walking through the home made observations of how staff communicate with people and found this to be with sensitivity, patience and respect. Staff spoken to said, we treat residents with respect at all times, The dementia can be distressing sometimes and so we especially make sure their dignity is protected. Care Homes for Older People Page 14 of 27 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. Social activities and meals are arranged to meet people needs, activities are varied and people have choice, however the choice of specialised activities for people with dementia conditions is limited. Evidence: We spoke to some of the staff about routines in the home. They said they are flexible and people can get up and go to bed when they choose. We saw two people using their rooms during the day. Most people living in the home were using the two lounges available to them or walking around the home. We saw this is encouraged as people with dementia conditions like to be able to move around freely but safely. We spoke to people in other parts of the home. One person enjoys sitting on the chair in the first floor landing. Staff told us people like to be mobile although they keep a check on peoples safety. Staff were seen to interact well with them, talking to them, spending time with them when they were having a drink or eating a meal. The interaction between staff and people living there was seen to be positive at all times during the inspection. Staff told us they like the way they can spend time with people, comments included, we have the time to spend with residents, they are all such characters, Care Homes for Older People Page 15 of 27 Evidence: and so different, they can be different every day. The lunchtime meal was being prepared and seen to be wholesome and nutritious. Most people eat in the dining room, however in some instances people have their meal with help from staff members either in their room or in the lounge area. This is carried out with dignity and staff spend time with the person without rushing them. Menus we looked at were balanced and the use of fresh produce is made available whenever possible. There is a designated chef who has worked at the home for a number of years and knows the dietary needs of the people living there including individual likes and dislikes. We saw the range of activities and how they are used which has been developed since the previous inspection, however specific activities designed for people with dementia conditions should be developed further so that people are being stimulated in a way which meets their specialist needs. There is an entertainer who visits the home, there are board games, staff assist people to take part in any activity, although there was seen to be choice if they choose to or not. Staff spoken to said they respect peoples wishes and due to the range of dementia conditions people can be unpredictable and so they use their knowledge of the person to assist them. Staff told us they have the time to take people out individually. They said that an increase in staffing levels has meant they have the time to do this on a regular basis. There are no restrictions for visitors to the home, however there were no visits during the time spent at the home. Care Homes for Older People Page 16 of 27 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. The arrangements for recording and responding to complaints are good making sure people feel listened to. Staff have access to safeguarding training for the protection of users of the service. Evidence: We looked at the homes complaints procedure, which is made available to residents and their relatives or advocates during the admission process. We were told by staff members we spoke to they are aware of the complaints procedures and how to use them. Comments included, we are told about complaints and how they are managed during our induction, people living here are really confused, but I think the family or their friends know who to talk to if they are not happy about anything. Comments we received in surveys from people told us they know what to do should they have any concerns. There have been no complaints made to the home or the Commission since the previous inspection. We spoke to the manager and staff about how people are protected. We found all staff have access to safeguarding training in order to ensure people are protected. Staff we spoke to said they have received training in this area and felt confident that they Care Homes for Older People Page 17 of 27 Evidence: would know what to do should any form of abuse be suspected, so that people are protected. Care Homes for Older People Page 18 of 27 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. North Shore nursing and residential home provides a safe and comfortable environment which is well maintained, decorated and furnished to a good standard. Evidence: This is a home where the maintenance and upkeep is taken seriously so that people living there have a comfortable environment in which to live. We found all the windows in the home have been replaced since the previous inspection, interior decoration has been carried out in communal areas as well as people rooms when they become vacant. Replacement flooring has also occurred on the rear staircase. Non slip floors in the communal areas and entrance hall mean that they are kept clean more easily. People we spoke to said this was a benefit. We saw people living there having the space to move around the two ground floor lounges freely. Some people use various seating points a round the home and we spoke to some of these people who appeared comfortable and familiar with their surroundings. There is a passenger lift to access the two upper floors of the home. Some of the people living there have good mobility and used the stairs to access the first floor. Care Homes for Older People Page 19 of 27 Evidence: We looked at some of people rooms. We found them to be a good size and they had various items of furniture, as well as specialist equipment including mobility aids in some rooms. All rooms had personal items which helps them to feel comfortable with familiar things around them. Some people like to use their rooms during the day time period and this is not seen to be a problem to the staff team. There is a patio area leading from the dining room for people to use. It has a range of seating and plants and flowers which people have access to. In addition there is seating at the front of the home which some people like to use with staff or family and friends in good weather. Mobility aids including hoists and specialist bathing facilitates meet the needs of people living there. Care Homes for Older People Page 20 of 27 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. Staffing arrangements and recruitment ensure that people are cared for and supported safely. Staff training is being developed so that they are meeting the needs of people living there. Evidence: We looked at the recruitment system the home has in place. By looking at three staff files it showed us staff are recruited safely using procedures which take into account full information about them including application records, references which have been checked, Criminal Record Bureau (CRB). Protection of Vulnerable Adults (POVA)checks to make sure they are safe to work with people who may be vulnerable. The home is being staffed at a level which meets the needs of people accommodated. We saw there is a good skills mix of staff working in the home, which makes sure people are receiving the care they need from a staff team who were seen to work well together as a team. Information from surveys and people we spoke to told us the staff team respect each other. Comments included, we are a strong team now and work well together, I like the way we work together and because there are more staff on now we have more time to do things with residents like taking them out or just talking to them. We were told that there has been an increase in staffing levels due to some people requiring one to one care. Staff told us they feel this has given them more time Care Homes for Older People Page 21 of 27 Evidence: to do tasks and have extra time to spend with people. Surveys we received and staff spoken to told us they feel supported by the management team. We saw there are supervision records for individual staff members and staff said they can talk to the manager at any time. We spent time in various areas of the home throughout the inspection process and found the staff team are available in all areas of the home at any one time, so that people have access to staff whenever they feel they need them. Call bells were responded to in a short time span so that people felt supported. We looked at what training is available to staff. In all instances a formal induction programme is taking place for all staff who come to work at the home this is overseen by the manager or senior staff. The staff induction is being reviewed to take into account of how a staff member is competent in areas of their role so that there is more than just a date and signature to show if they are competent in any one area. A new training package is being introduced by the home for all staff so that there is a range of courses available to meet the individual roles of staff members. The home provides access to national training at various levels in care practices. Training in dementia care has been attended by most staff working at the home. This training is ongoing so that all staff are developing their skills in this area for the benefit of people needing specialist dementia care. Staff we spoke to and surveys we received told us staff felt supported by the management team, and they felt motivated in working practices at the home. In general they felt they liked working at the home. Care Homes for Older People Page 22 of 27 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 manager and staff ensure the home is run in the best interest of people living there and that their safety and welfare are promoted and protected. Evidence: We saw the manager has the necessary skills and experience required to support staff and people living there on a day to day basis. Comments included, I feel the manager supports us, the manager is always available if you need her, If I feel I need to talk to the manager about something they always listen and things get done. There is evidence the general manager works closely with the registered manager to develop the service further. This is being carried out by reviewing the systems in place and making changes where necessary. We were told the home carries out surveys to get the views of people using the service, usually relatives and other professionals as people living there have limited communication abilities due to their dementia conditions. The quality monitoring of the home is being developed and includes more Care Homes for Older People Page 23 of 27 Evidence: staff and resident meetings so that people have the opportunity to provide comments about the service and its development. We found that all records and systems in the home have a review system in place so that changes can be identified and met on a regular basis.Staff were confident in using the systems available to them to make sure peoples needs are being met, and that these systems are being reviewed by the manager so that they are effective. The information we were provided with told us the home checks all appliances regularly for the health and safety of all users of the service. Care Homes for Older People Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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