Care Home: Shassab

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What the care home does well The home provides a specialist service for Asian people that maintains their privacy and dignity and respects their cultural and religious identity. Staff are skilled in communicating with people in their first language and in supporting them to maintain and further develop relationships that are important to them. Shassab was commended for providing a high quality choice of cultural and religious diets. What has improved since the last inspection? It was pleasing to find that significant improvements had been made since our last visit. The home`s environment had been brought up to standard and made safe and further improvements, including the provision of a new bathroom were planned. There was evidence of improvement in care planning and access to meaningful activities for people living in the home. The medication system had been made safe to ensure that people received their medicine exactly as prescribed by their doctors. Staff had received some of the training and development opportunities required to equip them with the knowledge and skills to meet the assessed needs of the people they support. Financial procedures had been improved to provide evidence that money belonging to the people accommodated could be accounted for. What the care home could do better: Our last inspection report highlighted the need to evidence that people have access to advocacy, services, which provide independent advice on taking decisions in the best interests of people using the service. The law relating to mental capacity and deprivation of liberty, places responsibilities for decision-making on providers of care. There had been some improvement by introducing systems that enabled people to express their views about the service they received, although the outcome of these consultations had not consistently been written down. It was evident that several people using this service lacked the mental capacity to take informed decisions about matters that were important to them. No assessments of people`s capacity had been undertaken and management and staff had not received training in recent legislation governing mental capacity or deprivation of liberty. Additionally, there was no evidence that people living in the home had access to advocacy services. One of the care plans we looked at contained out of date information about the person`s moving and handling needs. Improvements should be made by providing evidence that care plans are being audited on a regular basis. This will ensure that staff have access to accurate guidance on what they must do to keep people safe from harm. Staff had received training in recognising the signs and symptoms of abuse. It is important that training is also provided on the action they must take to comply with Manchester Social Services policy and procedures for reporting allegations orsuspicions of abuse. The self-assessment document submitted by this service did not give us clear information on what is being done to ensure that the service is run in the best interests of the people accommodated. This document should contain specific detail on what systems are being used to ensure a quality service is provided and where the written evidence of this can be found. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Shassab 144 Manchester Road Chorlton Manchester M16 0DZ     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: Val Bell     Date: 0 8 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: Shassab 144 Manchester Road Chorlton Manchester M16 0DZ 01618604596 F/P01618604596 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) : Mr Mohammad Iqbal care home 8 Number of places (if applicable): Under 65 Over 65 0 1 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 7 0 All service users are offered the option of a single bedroom. (Service users share bedrooms only where two service users choose to share and have been offered two rooms to use). Minimum staffing levels will be maintained in accordance with the Residential Forum guidelines `Care Staffing in Care Homes for Younger Adults` and service users` assessed levels of need. One named service user whose primary need for care and accommodation is old age (OP) is accommodated. If the service user leaves the home the registration will revert to Mental Disorder (18 to 65 years of age, excluding learning disability and dementia). The care home provides a separate room where service users can meet visitors in private. The home accommodates a maximum of 7 service users, aged 18 - 64 years, whose primary need for care arises from mental disorder (excluding learning disability and dementia). The service should, at all times,employ a suitably qualified and experienced manager Care Homes for Adults (18-65 years) Page 4 of 28 who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Shassab is a residential care home providing 24-hour personal care and accommodation for 8 adults with mental health problems. The service specialises in culturally appropriate care of Asian people. The home is situated on the edge of Chorlton, South Manchester, close to local amenities and public transport routes. It is sited on a residential street and is of the same size and style as other houses surrounding it. It has a small car park to the front and a concreted outdoor area to the rear. Bedroom accommodation is on the ground and first floors. There are 6 single and one double bedroom with hand washbasins. The home has access for people who require wheelchairs for mobility. The communal space is situated on the ground floor along with kitchen and laundry facilities. Information about the home is available on request and via the Care Quality Commission Web site. The charges for the home are £343.24 per week. 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: two star good 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 an unannounced key inspection, which means that the manager was not told we were coming to visit. Our visit was just one part of the inspection. We looked at other information we had about the home, including events that the home had told us about since our last visit. The manager completed and submitted an Annual Quality Assurance Assessment, which is a self-assessment document prior to our visit. Ten surveys were completed by staff and returned to the Commission. We spoke to staff, management and a person living in the home to ask their views on the quality of the service being provided. We looked at policies and procedures, care records and other documents such as complaints and health and safety records. We walked round the home to assess the Care Homes for Adults (18-65 years) Page 6 of 28 quality of the environment provided for people living in the home. What the care home does well: What has improved since the last inspection? What they could do better: Our last inspection report highlighted the need to evidence that people have access to advocacy, services, which provide independent advice on taking decisions in the best interests of people using the service. The law relating to mental capacity and deprivation of liberty, places responsibilities for decision-making on providers of care. There had been some improvement by introducing systems that enabled people to express their views about the service they received, although the outcome of these consultations had not consistently been written down. It was evident that several people using this service lacked the mental capacity to take informed decisions about matters that were important to them. No assessments of peoples capacity had been undertaken and management and staff had not received training in recent legislation governing mental capacity or deprivation of liberty. Additionally, there was no evidence that people living in the home had access to advocacy services. One of the care plans we looked at contained out of date information about the persons moving and handling needs. Improvements should be made by providing evidence that care plans are being audited on a regular basis. This will ensure that staff have access to accurate guidance on what they must do to keep people safe from harm. Staff had received training in recognising the signs and symptoms of abuse. It is important that training is also provided on the action they must take to comply with Manchester Social Services policy and procedures for reporting allegations or Care Homes for Adults (18-65 years) Page 8 of 28 suspicions of abuse. The self-assessment document submitted by this service did not give us clear information on what is being done to ensure that the service is run in the best interests of the people accommodated. This document should contain specific detail on what systems are being used to ensure a quality service is provided and where the written evidence of this can be found. 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 9 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 10 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. There is a good system in place to assess and monitor peoples needs and ensure that these will be met. Evidence: There had been no admissions since we last carried out an inspection of this home. We looked at the assessment process in place and found it to contain relevant information in relation to the assessment of peoples needs. People accommodated in the home had been issued with contracts for the care and support they received from this service. We looked at the care records belonging to two people living in the home. One of these records had been reviewed and updated to reflect the persons changing needs. The second persons records had not been consistently kept up to date in relation to his moving and handling needs. The manager said this was because his key worker had been absent from work. There should be a system in place to audit care records at Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: regular intervals to ensure that they reflect the current needs of the people accommodated and include written instructions on how these needs will be met. There was no evidence to suggest that this persons welfare had been affected by this oversight and staff spoken to were knowledgeable about the persons current moving and handling needs. It was particularly pleasing to find that peoples religious and cultural needs had been recognised and were consistently being met. Care Homes for Adults (18-65 years) Page 12 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 who live at Shassab have their needs met and their care is provided in a manner that maintains their privacy and dignity. Evidence: The two care plans we examined had been drawn up from the individuals assessments of need. There was good detail on how individuals religious, privacy and dignity needs were to be met and daily records generally provided evidence that care plans were being followed. More detail was needed to provide guidance for staff on what they must do to meet each persons specific needs in relation to risk. One of the care plans had not been reviewed since September 2007. This referred to the use of a hoist, although the person was currently using a slide board to get in and out of bed. There were no written guidelines to inform staff about how to use the slide board safely. However, staff were found to be knowledgeable about safe moving and handling procedures. A second care plan was not dated, which made it impossible to determine if the information was current. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: One of the care plans contained a signed statement authorising staff to purchase personal items on behalf of the individual. No assessment of this persons capacity to make this decision had been undertaken and none of the management or staff working in the home had received training in the Mental Capacity Act. Furthermore, there was no evidence that people living in the home had access to advocacy services. The manager must provide evidence that important decisions taken on behalf of people living in the home are made in their best interests. Care Homes for Adults (18-65 years) Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Shassab are provided with activities and a variety of home cooked food, which they enjoy. Evidence: Since our last visit there had been significant improvement in meeting the social and leisure needs of people living in the home. Activities provided on a regular basis included trips out for shopping, visits to parks and libraries, table-top games and events to celebrate cultural and religious festivals. At the time of this visit staff were planning a trip to a theme park for people accommodated in the home. Staff continued to support peoples religious needs by organising structured programmes of prayer and enabling access to local mosques. Routines in the home were flexible and people were being encouraged to express their Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: views and emotions at daily chat sessions, facilitated by a member of staff. Service users also received support to maintain regular contact with the people who were important to them. We joined a group of staff for the midday meal that had been provided to the people accommodated in the home. The meal comprised of several varieties of curries and baltis, salad, naan bread, chappatis and several desserts. The quality and variety of the food was outstanding and the mealtime provided a meaningful social occasion, consistent with the cultural and religious needs of people living in the home. One person told us that he thoroughly enjoyed the meals and the variety of different dishes provided at every mealtime. We looked at the food storage areas and found that people living in the home had access to ample provisions for meals and snacks according to their preferences and choice. Care Homes for Adults (18-65 years) Page 16 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. Peoples health and personal care needs were met according to their individual preferences. Evidence: Care plans clearly detailed what staff must do to meet the personal and health care needs of people living in the home. This included providing support according to the preferences of individuals. Records provided evidence that people had access to the full range of health care services and that health professionals advice and guidance was being consistently followed. We examined the system used for administering medication. Records appeared to be accurate and medication was stored securely. Improvements had been made to meet the requirements made the last time we visited. This ensured that people living in the home were receiving their medication exactly as prescribed by their doctors. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to listen to peoples concerns and afford protection to their welfare and safety. Evidence: The homes complaints procedure clearly set out the process for people living in the home to express concerns about the service they received. Daily chat sessions, facilitated by a member of staff, provided opportunities for people to express their views about the care they received. This process for accessing the views of people living in the home could be improved by ensuring that people have access to advocacy services. No complaints had been recorded in the previous twelve months. Since our last visit a copy of Manchesters Safeguarding Adults policy had been obtained and staff had received training in how to recognise abuse. However, management and staff had not attended the local authoritys training on the procedures for reporting allegations or suspicions of abuse. The manager said that it was difficult to release staff for external training and that they found it more cost effective to employ a training agency to deliver training to staff in-house. It is important that the management attend Manchesters training in safeguarding adults and share their knowledge of the process for reporting abuse with staff working in the home. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Improvements had been made to the way personal finances were accounted for to provide a safe system of recording the income and expenditure for people using this service. 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. A clean and well maintained environment is provided for people using this service. Evidence: Since our last visit significant improvements had been made to bring the environment up to standard. The home had benefitted from a full redecoration and the repairs required in the last inspection report had been carried out satisfactorily. The selfassessment completed by the manager told us that a new bathroom would be fitted during the next twelve months. The home was clean and hygienic and no unpleasant odours were detected. Suitable laundry facilities were provided and staff were observed to follow good practice in the control of infection. No health and safety issues were found during our visit. Care Homes for Adults (18-65 years) Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Shassab are supported by a team of staff who know them well, but as staff have not been trained in legislation governing mental capacity and deprivation of liberty, important decisions taken on their behalf may not be in their best interests. Evidence: Sufficient staff were on duty when we visited the home and improvements had been made to the rota by identifying the named staff on duty each day. However, one person due to work that day had been replaced by another member of staff and this had not been recorded on the rota. Rotas should accurately record the names of staff working on each shift. We looked at the personnel file for a member of staff who had been recruited since we last visited. Records provided evidence that rigorous recruitment procedures had been followed to ensure that staff were suitable to work with people living in the home. Following appointment, new staff are provided with an induction that meets the specifications of the Skills for Care Induction Programme and their progress is monitored by senior staff working in the home. Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: Records provided evidence that staff had access to appropriate ongoing training to ensure that they continued to develop the skills and knowledge to meet the needs of the people using the service. However, we were concerned that people using the service did not have assessments of their capacity to make important decisions that affected their lives. The manager and staff team must update their knowledge of their responsibilities governed by legislation covering mental capacity and deprivation of liberty to ensure that the human and civil rights of people living in the home are upheld. Ten staff working in the home completed surveys and returned these to the Commission. All the staff were positive about the support they received from management and felt that the service was good at listening to the views of people living in the home and meeting their assessed needs. One member of staff commented that the service does well in meeting the service users physical, mental health and cultural needs. Care Homes for Adults (18-65 years) Page 22 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. People live in a well managed, safe home. Evidence: Since we last visited significant improvements had been made to the way the home was being managed. The requirements made at the last inspection had been addressed and it was pleasing to find that further improvements were planned. The self-assessment completed by the manager did not provide us with all the information we needed. For example, in answer to the question What we do well the response was We regularly check that all is running accordingly. Information provided in the self-assessment should specify what action has been taken and where the written evidence of this can be found. It was pleasing to find that the service was developing a quality assurance system based on the views of people living in the home. This can be further improved by making sure that all meetings with people using the service are recorded along with the action taken in response to their views and suggestions for improvement. Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: We looked at a sample of health and safety records and found these to be accurate and up to date. Care Homes for Adults (18-65 years) Page 24 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 25 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 7 12 Evidence must be provided to demonstrate that decisions taken on behalf of people are consistent with the requirements of The Mental Capacity Act. Decisions taken on behalf of people who lack capacity must be made in their best interests. 08/07/2009 2 35 18 Management and staff must 08/08/2009 update their knowledge of their responsibilities governed by mental capacity and deprivation of liberty. Management and staff must provide evidence that decisions taken on behalf of people are in their best interests. 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. Care Homes for Adults (18-65 years) Page 26 of 28 No. Refer to Standard Good Practice Recommendations 1 2 There should be a system in place to monitor, review and update care records to reflect the changing needs of individuals using this service. This will ensure that care records provide evidence that the current needs of the people accommodated are being met. The homes system for accessing the views of people living in the home could be improved by enabling people to access advocacy services. This will provide opportunities for people to access independent advice on decision-making and expressing concerns. Rotas should accurately record the names of staff working on each shift. The Annual Quality Assurance Assessment should contain details of the action taken to meet the National Minimum Standards and where evidence of this can be found. This will provide evidence that the home is being run in the best interests of the people using the service. 2 22 3 4 33 37 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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