Care Home: Premier Court Nursing & Residential Home

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What the care home does well People continue to express confidence in the current manager who has now been in post for one year. One person told us `Premier Court has a great atmosphere of genuine care and thoughtfulness`. Another person said `It is a happy and very caring place. Our experience has always been positive`. Two people told us the manager was very `approachable on all matters`. People tell us they have good relationships with the staff who they are familiar with as there is currently limited use of agency staff. Residents describe staff as `friendly` and `cheerful`. People are able to take part in a varied programme of activities that will stimulate and entertain. Their relatives feel welcome at Premier Court and are encouraged to join in. People enjoy a choice of freshly cooked meals that are well presented and support their dietary needs and individual preferences. What has improved since the last inspection? Improvements in monitoring people`s fluid intake, where they are not able to manage this for themselves, has been maintained. People`s individual care plans are being updated more consistently so that responses to changes in their health and care needs can be monitored and the action taken by staff recorded. Staff have been working closely with the local hospice to support people`s comfort and symptom control. Refurbishment work has continued to address the areas of heavy wear and tear we identified last June. What the care home could do better: To fulfill it`s legal responsibilities BUPA need to submit an application to the Care Quality Commission to register a manager for this service. The company need to continue with their efforts to recruit a deputy manager to support the management functions within the home, focus on the clinical needs of the people who live at Premier Court and ensure a consistent approach from staff. BUPA need to review the environment on the dementia care unit so that the lighting is improved and it is kept free of odours. Key inspection report Care homes for older people Name: Address: Premier Court Nursing & Residential Home Thorley Lane East Thorley Bishops Stortford Hertfordshire CM23 4BH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sheila Knopp     Date: 2 5 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Premier Court Nursing & Residential Home Thorley Lane East Thorley Bishops Stortford Hertfordshire CM23 4BH 01279758585 01279758586 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: This home may accommodate 1 named female service user in category MD(E) The Commission is to be be informed if the named service user leaves the home permanently for any reason and the registration will be amended removing this category. Date of last inspection Brief description of the care home Premier Court is a purpose-built care home providing nursing and personal care with accommodation for 59 older people. Twenty two people with a diagnosis of dementia may be accommodated within the overall capacity of the home. It is owned and operated by BUPA Care Homes Limited and is situated on the outskirts of Bishops Stortford in a pleasant semi-rural setting. The home is on one floor and is built around Care Homes for Older People Page 4 of 27 Over 65 0 1 59 22 0 0 Brief description of the care home a courtyard garden to which a number of bedrooms have direct access. However the building has recently been split into two areas to accommodate a unit for people with dementia. All rooms are for single occupancy and have en-suite toilets and wash hand basins. There is a large dining room and lounge for the main group of people living at Premier Court. The dementia care unit has a small lounge and dining room. The home also has a hairdressing salon, kitchen and laundry that, together with aids such as assisted bathing and toilet facilities, ramps and wide corridors, provide for the needs of older people. There are several small garden areas around the outside of the building, including a newly developed sensory garden and secure garden at the side of the unit for people with dementia. Parking is available at the front of the building. The home has a range of documents providing details of its terms and conditions including a Service Users Guide and Statement of Purpose. Copies of these including the latest inspection report can be requested from the manager. The current fee rates range from £918.70 per week for residential care, £1041.45 per week for nursing care and dementia care nursing. Respite stays are charged at £153.70 per day. Fee rates correct on 25/3/10. Variable rates per room are charged to funding authorities. Personal toiletries, newspapers, hairdressing, optician, chiropody and dentistry are subject to additional charges. 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: The information in this report is based on an unannounced visit to Premier Court by one inspector between 09:30 and 18:10 hours. To review the experience of people who live at Premier Court we observed how people spent their time and the quality of the interaction they had with staff during the morning and afternoon and over lunch. We were able to speak with residents individually in their rooms and in small groups during the morning pampering session that took place in the main lounge. We also spoke with relatives, representatives of the different staff groups on duty and the manager. We reviewed relevant care, personnel and health and safety records. We have reviewed the information we have received about this service since our last key inspection which was completed on 26th June 2009. Following that inspection we carried out two further unannounced inspections on 29th October and 9th November Care Homes for Older People Page 6 of 27 2009. We are now able to confirm that issues arising out of these inspections have been addressed. These included some changes to the way medicines were recorded and stored and monitoring of fluid intake and weight changes. We made survey forms available to 10 residents and 10 staff so the views of a wider group of people could be included in our assessment of the service. Responses were received from 8 residents and 5 staff. We have not received any complaints about this service between our key inspections and the manager has kept us informed about events that take place in the home, that we need to be notified of. We have also looked at the managers Annual Quality Assurance Assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also provides us with numerical data. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 27 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. People looking to move into Premier Court will be involved in an assessment of their nursing and care needs to make sure it is a suitable place for them to live and staff will be able to support them. Evidence: We had conversations with three people who had recently come to stay at Premier Court. They were happy with the support they were receiving. One person said you couldnt ask for more, Im very happy here. Their care records confirmed that a preadmission assessment had been completed and relatives and community health care professionals who knew the person concerned had also been involved. Any specialist equipment that people need to support them is identified before they move so it available when they arrive. All 8 residents who completed our surveys, with the help of relatives, confirmed they had received enough information about Premier Court to help them decide if it was the Care Homes for Older People Page 11 of 27 Evidence: right place to be. People receive a contract setting out the terms and conditions of their stay. BUPA carried out a recent (23/3/10) routine audit of financial systems within the home, which checked people had signed contracts in place and were receiving accurate bills. 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. People can be confident that the nursing and personal care provided will reflect their individual needs and respect their privacy and dignity. Evidence: To assess the personal and nursing care people receive we visited people in their rooms who are receiving a high level of support. People spending time in bed appeared to be comfortable. They had drinks and call bells to hand where appropriate. Pressure relieving equipment and adjustable beds are in place to prevent pressure sores and assist with positioning and moving and handling. Seven (88 ) out of eight people who completed our survey said they usually received the care they needed. One person said this was always the case. We reviewed the care records of 4 people we had contact with during our visit. Overall the systems for assessing and recording each persons care needs, keeping them up to date and reviewing any risks identified had improved. There are still some inconstancies within the nursing records, which make it more difficult to track changes Care Homes for Older People Page 13 of 27 Evidence: if staff are recording information on different forms. We discussed these issues, including the format of care plans for people on respite stays, with the manager. She has arranged for the nursing staff to receive training in relation to their accountability to maintain accurate records and needs to address any concerns with individuals as part of their performance management. The food and fluid intake of people who are not able to maintain this for themselves was being monitored. People are weighed regularly and have their Body Mass Index assessed. Last year the registered nurses received additional training and support from a tissue viability nurse in relation to managing wounds and pressure sores. A monthly audit is completed and together with each persons wound care records provides evidence of the treatment being given and its effect. Our review of care records and discussions with staff confirmed people living in the home have regular access to local general practitioners and community health services. Six (75 ) out of 8 people who completed our survey said they always received the medical care they needed. Two people said this was usually the case. Staff have been working closely with the palliative care team at Isabel Hospice to enable people with terminal illnesses to be supported at Premier Court. We reviewed the systems in place for ordering, storing, administering and disposing of medicines. Regular audits are carried out to check the safety of the systems in place. Our last random inspection confirmed action had been taken to address the issues raised by a Care Quality Commission Pharmacist. 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. People will be invited to take part in a range of social actives, events and entertainment that are arranged to encourage a sense of community and to provide stimulation. People enjoy the choice of freshly cooked meals that are served to them. Evidence: Details of a varied activity programme and pictures of social events that take place are on display. People are positive about their contact with the two activity organisers who spend time with individuals and provide opportunities for small groups of people to get together as well as organising visiting entertainers and arranging themed events. The main lounge at the front of Premier Court provides a focus for the activities, events and entertainment that takes place. Residents who completed our survey said The activities manager is very good, there are always activities to take part in. Visitors tell us they feel welcome at Premier Court. They are invited to take part in activities and social events. People are supported to spend time with their partners Care Homes for Older People Page 15 of 27 Evidence: and have meals together. People are offered a choice of freshly cooked meals that are well presented and suited to their dietary needs and individual preferences. Most people have their meals in the dining room but we met people who preferred to have some of their meals brought to their room. People had access to drinks during the day whether they were in their room or a public area of 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. People can be confident that the manager will take action to address any concerns they have and staff receive the training they need to understand their role in protecting people from abuse. Evidence: Five out of eight people who completed our survey confirmed staff usually listened to them. Two people said staff always listened to them. Everyone said they could speak to someone informally if they had a concern and knew how to make a formal complaint should this be required. BUPA have introduced a new system for monitoring and tracking concerns brought to the manager & companys attention. People are also invited to make suggestions and fill in comment cards. The manager keeps a record of compliments and complaints received. These records tells us that any concerns are dealt with professionally and people receive a response within the timescales set out in the BUPA complaint procedure. Staff receive training to understand and recognise their responsibilities in relation to protecting people from abuse. The manager has a good understanding of the Hertfordshire County Council Safeguarding Vulnerable Adult procedure, which care homes are expected to follow and works well with the other professional groups involved. The Manager and BUPA are responding to the changes brought about by the Mental Care Homes for Older People Page 17 of 27 Evidence: Capacity Act, which requires staff to demonstrate people are involved in decisions about their lives and are being made in their best interests. The manager reported she has completed a train the trainers course on the requirements of the act and how it relates to the service provided at Premier Court, so that information can be passed on to staff. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. For the majority of people Premier Court provides them with comfortable, fresh, clean accommodation to live in. However more attention is needed to review the accommodation for people who have dementia to ensure it is suitable for their needs and odour free. Evidence: Overall Premier Court provides people with a comfortable environment to live in. Each room has an en-suite toilet and the main communal areas are bright and spacious. Assisted bathrooms are provided for people with complex needs who require support. The courtyard garden in the centre of the building and garden areas around the outside of the building are well maintained and provide a variety of areas to spend time in. People are able to add personal belongings and effects to their rooms so they feel at home and have familiar things around them. Work has continued in the last year to address the refurbishment issues that we reported last June. This has included decorating bedrooms and replacing flooring where this was needed. What does not work so well is the small enclosed unit at the back of the building, Care Homes for Older People Page 19 of 27 Evidence: created by a previous manager, for people who have dementia. The lighting is this area is very poor as it is largely provided by up-lighters. As bedrooms are straight off a main corridor with a lounge and dining room at either end there is little opportunity to provide purposeful routes for people to walk in. There is a small enclosed garden that people can spend time in. The main area of the home was fresh and clean on the day we visited. However there are areas of the dementia care unit, where a noticeably strong odour was present. This was dealt with several times during the day by the domestic staff but reoccurred as fluids have been absorbed into the flooring. Further action is needed to review the effects of dis-inhibited behaviour shown by some residents who have dementia and provide suitable floor covering and deodorisers. We discussed this with the manager at the time of the inspection and it was agreed she would seek further advice on how to manage this in a dementia care setting. People who completed our survey told us the home was always/usually fresh and clean. One person added there was sometimes an odour at weekends. There are systems in place to provide staff with the personal protective equipment they need to prevent the spread of infection. Liquid soap and disposable hand towels are provided in all bedrooms and communal toilets and bathrooms to promote good hand hygiene. There is a large industrial scale laundry that caters for the needs of people living and working within the home. The manager told us that BUPA are currently reviewing their infection control policies and procedures in light of changing practices and legislation. 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. People can be confident that they will be supported by staff who have been checked for their suitability to work with vulnerable people and receive the training they need to care for people safely. Evidence: The people we spoke to and who completed our survey were positive about their relationships with staff. One person told us All staff are very friendly and helpful. From the care staff, cleaners, laundry staff, nurses catering staff and office staff, nothing ever seems too much trouble. The five staff who completed out survey demonstrated a positive approach to the care of residents and confidence in the management support and training provided. On the day we visited there appeared to sufficient nursing, care, housekeeping, catering and administrative staff available to meet peoples needs. However two people said they had experienced occasions when it took a long time for staff to answer call bells at busy times of the day. The call system enables the manager to check response times. She reported she keeps this under review and has allocated staff at specific times to be responsible for answering call bells to reduce waiting times while staff are, for example, supporting people at meal times. Care Homes for Older People Page 21 of 27 Evidence: We looked at the recruitment and training records for 4 staff. This confirmed detailed applications forms are received, appropriate references taken up and criminal records checks obtained before people start work. The personal identity numbers for the registered nurses are checked with the Nursing and Midwifery Council. There is a programme in place to provide staff with an induction as they start work and to support on-going training and updates. This includes an induction check list for agency staff supplied to the home. The manager has access to additional hours from a company trainer to review and update the training needs of the staff team. The number of care staff with National Vocational Qualifications (NVQ) at level 2 in care has not yet reached the benchmark standard of 50 . The manager identified limited opportunities for staff to attend NVQ training organised by BUPA and has now gained access to alternative training. Eleven staff have been signed up for NVQ courses, which should address this issue. 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. People can be confident that the service will be run in their best interest because BUPA has quality assurance systems in place that look at the safety and experience of people who live and work in the home. Evidence: The current manager, Debbie Pegram, has been in post for a year. People continue to tell us that she is making a difference to the way Premier Court is run and is approachable. One person said She will always act if you have any questions about care. We need an application from BUPA to register the manager with us as the registering authority. The company have not been able to recruit a deputy manager. We see this as a key role to support the manager, particularly in taking a lead in care matters so staff are Care Homes for Older People Page 23 of 27 Evidence: consistently working to the policies and procedures in place and to support the programme of staff supervision. BUPA are continuing to review the provision of dementia care within this service, in relation to the skills and experience of staff available to support this specialist area and the suitability of the accommodation provided. The manager reported that no recent permanent admissions under this category have taken place. Senior BUPA managers make regular visits to the home to review the quality of the care provided through regular audits. The manager sent us the Annual Quality Assurance Assessment within the timescales we set. We found the information provided was reliable and reflects on the action needed by the manager to maintain and address the strengths and weaknesses within the service. The manager has kept us informed about events in the home as required and there has been a decrease in the number and level of issues arising. BUPA carry out annual Resident Customer Satisfaction surveys. The 2009 survey, involving responses from 20 out of 30 people who received questionnaires identified a 23 increase in the overall rating for the service provided. There are clear systems in place to track all transactions. People are able to deposit personal money with the administrator so they have access to it. There are clear systems in place to track all transactions. BUPAs financial auditors had recently carried out a full review, which did not raise any issues in this area. There are clear well organised systems in place to make sure health and safety systems within the home are monitored and equipment is regularly serviced. Staff receive regular training in safe working practices and risks associated with the use of specialist equipment are identified. 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 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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