Care Home: Sibbertoft Manor Nursing Home

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What the care home does well Care plans are devised for each person by looking a the specific areas that they needed care and support in. This means that each persons care plans is very individual and specific to the person`s personal needs and preferences. Records show that people are encouraged to make choices and to remain as independent as they are able to. Where people have specific health problems care plans detail how they should be cared for and any specific symptoms that staff should be vigilant for. A staff member told us "everybody really does care" One person told us "I am really happy here - staff take care of everything for me." The home employs two activity co-ordinators who work in the afternoon to do activities such as quizzes, discussion groups and games. This is in addition to the external entertainers that come into the home. All of the bedrooms are spacious, with many people bring in their own items of furniture such as arm chairs, settees and display cabinets. This gives each of the rooms an individual feel. All of the communal areas are decorated and furnished to a high standard with plants, pictures and fresh flowers giving a homely atmosphere. The grounds are pleasant and well maintained. The manager explained that in the summer people like to spend time outside sitting on the patio which has a number of chairs and tables. Hanging baskets and tubs make this an attractive area for people to sit in the warmer weather. The manager described the staff as "very committed" saying that they all knew the people living in the home well. One member of staff told us "we look after people as if they were our own relatives." The manager told us that the home carries out a satisfaction survey annually. The results were viewed and were generally very positive. One person who lives at the home commented "A very well run home with good, caring staff." and said it is "lovely living here." What has improved since the last inspection? A new wing has been opened to accommodate twelve people. The garden has been developed to include more seating and a walkway. A second activities co-ordinator has been employed. What the care home could do better: The administration of medication is generally well managed but there were some occasions where entries on the medication record had not been signed. It was noted that on a number of people`s care plans it stated that they should not be resuscitated in the event of their death. There was no record of how this decision had been reached, whether the person had the mental capacity to make that decision or who else had been involved in the decision making process. References for one person who had worked at the home for several years were not available on their file. Key inspection report Care homes for older people Name: Address: Sibbertoft Manor Nursing Home Church Street Sibbertoft Market Harborough Leicestershire LE16 9UA     The quality rating for this care home is:   three star excellent 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: Catherine Perrins     Date: 2 2 1 2 2 0 0 9 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 28 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 28 Information about the care home Name of care home: Address: Sibbertoft Manor Nursing Home Church Street Sibbertoft Market Harborough Leicestershire LE16 9UA 01858881304 01858881488 matron@sibbertoftmanor.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pretty 333 Limited Name of registered manager (if applicable) Mrs Patricia Margaret Bevin Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accomodated is: 40 The registered person may provide the following category of service only: Care home with nursing-code N To be able to admit the named person of category PD named in variation application number V35746 dated 9 October 2006. To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category-code OP Dementia-code DE Date of last inspection 0 0 Over 65 15 40 Care Homes for Older People Page 4 of 28 Brief description of the care home Sibbertoft Manor provides nursing & residential care for up to 40 people over the age of 65 years. The home is situated in the pleasant village of Sibbertoft, on the boarders of Leicestershire and Northamptonshire, and is set within its own extensive, enclosed grounds overlooking open countryside. All of the bedrooms are spacious and include en-suite facilities. The communal areas within the home are furnished to a high standard, there are separate sitting rooms, including a quiet room, dining areas. All areas of the home and garden are well maintained and made accessible to residents with limited mobility. There is a passenger lift to the first floors. The home has a minibus and there are ample car-parking facilities within the grounds to the home. Fees are 880 pounds per week. This is inclusive of of hairdressing, chiropody, newspapers and alcohol. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home 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 quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. This was an unannounced key inspection which means that we focused on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for people using the service. As part of the preparation for this inspection a period of three hours was spent reviewing the information that CQC has about this service. We looked at all the information that we have received, or asked for, since the last key inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. Care Homes for Older People Page 6 of 28 The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. The inspection visit lasted seven hours during the morning and afternoon of a weekday. During the inspection three people were case tracked. This involves looking in detail at all aspects of their care and experiences at Sibbertoft Manor, including looking as their individual plans of care and other records, talking to them and talking to their care staff. Because people with dementia are not always able to tell us about their experiences we also used observations of peoples state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. The registered manager was present for the inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The administration of medication is generally well managed but there were some Care Homes for Older People Page 8 of 28 occasions where entries on the medication record had not been signed. It was noted that on a number of peoples care plans it stated that they should not be resuscitated in the event of their death. There was no record of how this decision had been reached, whether the person had the mental capacity to make that decision or who else had been involved in the decision making process. References for one person who had worked at the home for several years were not available on their file. 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. 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 28 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 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 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 are given good information and their needs are thoroughly assessed before they move to the home. This helps to make sure that the home can meet their needs and expectations. Evidence: The home has a combined statement of purpose and service user guide which gives people good information about the home and the services it offers. This is useful in the admission process, to give information to prospective people coming into the home. The statement of purpose / service user guide are available in an audio format to make them easier for people to access the information if they were unable to read the printed copy. Records show that peoples needs are assessed before they move to Sibbertoft Manor to make sure that the home is right for them. Care Homes for Older People Page 11 of 28 Evidence: The manager explained that people are able to visit the home before they move in to help them decide if it is the right move for them. If they are not able to visit, their relatives or friends can do so on their behalf. Care Homes for Older People Page 12 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care and health care needs are met by staff who understand their needs and deliver care in a respectful manner. Evidence: Each person who lives at the home has an individual plan of care. This contains their care plans and other information that staff need to care for people in the right way. Care plans are devised for each person by looking at the specific areas that they needed care and support in. This means that each persons care plans is very individual and specific to the persons personal needs and preferences. As well as giving staff detailed information such as the support people need with eating and drinking, personal care, mobility, and to maintain good health, care plans contained details such as what time they liked to get up and go to bed, whether they like the light on or off at night and their preferred name. Records show that people are encouraged to make choices and to remain as independent as they are able to. For example choosing their clothes, what to eat and Care Homes for Older People Page 13 of 28 Evidence: where to spend their time. Care plans reminded staff of the need to respect peoples dignity and advised how this should be done for each person. Where people have specific health problems care plans detail how they should be cared for and any specific symptoms that staff should be vigilant for. Recognised assessments and screening tools are used to assess people for the risk of falls, moving and handling and nutrition. At a recent review meeting for one of the people living at the home, a relative commented that the family were more than happy with the care you give mother - it is lovely to see her sparkle back. A staff member told us everybody really does care Records show that people had been assessed to find out if they are at risk of developing pressure sores. Where it is identified that there is a risk, measures are put in place to reduce the risk, such as provision of specialist equipment and helping people to change position regularly. There was also evidence of advice and input being sought from General practitioners, district nurses and the tissue viability nurse. In order to ensure that the progress of any sores can be monitored details are recorded in a separate file as well as it the persons individual file. The manager explained that staff encourage people to be well hydrated by having a trolley in each lounge with water and juice available throughout the day. Where people are unable to access drinks independently staff were seen offering assistance. The administration of medication is generally well managed but there were several instances where entries on the medication record had not been signed. The medication that had not been signed for was prescribed to be given at specific times of day, for example breakfast time or lunch time rather than to be taken as required. Controlled drugs were being stored and their administration recorded in line with the Misuse of Drugs Act regulations. Controlled drugs are prescribed medicines which some people abuse them by taking them when they have not been prescribed, there are laws and regulations about how these drugs should be stored and administered. Care Homes for Older People Page 14 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a good quality of life with a range of activities and entertainment. Evidence: A list of the activities and entertainment available for the month from external entertainers and individuals is displayed in the hall. For December the list included a singer, carols, reflexology, library and motivation therapy. The manager explained that most of the entertainment takes place in the main house but people from the new wing can come over to join in if they wish to. The home employs two activity coordinators who work in the afternoon to do activities such as quizzes, discussion groups and games. The manager told us that the activity coordinators spend time in the main house and the new wing. One person told us that he enjoys listening to talking books. Another person said, I am really happy here - staff take care of everything for me. Lunch was observed during the inspection. Staff were seen assisting people in sensitive manner, talking to them and explaining what the food was. People told us that the food was good. It was noted that salt and pepper were available on the dining tables along with napkins for each person. The cook explained that people are able to choose food from the menu, or if they do not like what is on the menu she can prepare them another dish of their Care Homes for Older People Page 15 of 28 Evidence: choice. People told us that they were able to receive visitors whenever they wanted to. Records show that monthly church services are held within the home. Care Homes for Older People Page 16 of 28 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 home has a robust complaints procedure and good staff awareness and attitudes to the Safeguarding of Adults means that people feel safe and were well protected. Evidence: The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. A copy of this is displayed on the notice board in the hallway of the main house. The manager said that the home has not received any complaints in the previous twelve months or made any alerts to the Local Authority under the locally agreed safeguarding adults procedure. Staff spoken to had a good knowledge of how to safeguard adults and their responsibilities under the locally agreed procedures. Responses to satisfaction surveys carried out by the home state that people living in the home and their relatives know how to raise any concerns that they may have. It was noted that on a number of peoples care plans it stated that they should not be resuscitated in the event of their death. There was no record of how this decision had been reached, whether the person had the mental capacity to make that decision or who else had been involved in the decision making process. The home have not made any applications to the Local Authority under the deprivation Care Homes for Older People Page 17 of 28 Evidence: of liberty safeguards and observations made during the inspection suggest that people are able to move around the home freely and do not have any restrictions placed on them. Care Homes for Older People Page 18 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, 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a well maintained, comfortable and spacious place to live. Evidence: Sibbertoft Manor consists of the main house which has been extended to the rear and was the former manor house. In October 2009 a separate wing was opened within the grounds. There are twenty four bedrooms within the main house and twelve in the new wing. Two of the bedrooms in the main house are double rooms. All of the bedrooms are spacious, with many people bring in their own items of furniture such as arm chairs, settees and display cabinets. This gives each of the rooms an individual feel. Many of the bedrooms had bird tables or feeders close to the windows. One person told us that he likes to sit in his room and watch the birds. All of the bedrooms have en suite bath or shower rooms. Each of the bedrooms has a telephone point and a television point with Sky television available if people want it. Each bedroom also has an individual thermostat so that people can control the temperature of their room. There are two lounge areas downstairs in the main building. The manager explained that one is a quiet lounge and the other usually has the television on. Sliding doors Care Homes for Older People Page 19 of 28 Evidence: between these two rooms mean that they can be opened up into one large area if, for example, there is an entertainer. There is also a communal dining room downstairs and a further seated area in the hallway at the bottom of the stairs. On the first floor there is another lounge which has a small dining area. The manager explained that one person likes to dine their with his wife when she visits. In the garden wing there is a large lounge with a dining area. All of the communal areas are decorated and furnished to a high standard with plants, pictures and fresh flowers giving a homely atmosphere. At the time of inspection the home had a large Christmas tree in the inner hallway and decorations in the communal areas. There is a large kitchen in the main house and a smaller one in the garden wing. As well as the en suite facilities there are a number of communal toilet and bathrooms. The home has an on site laundry which is situated in an outbuilding in the grounds. The grounds are pleasant and well maintained. The manager explained that in the summer people like to spend time outside sitting on the patio which has a number of chairs and tables. Hanging baskets and tubs make this an attractive area for people to sit in the warmer weather. The manager explained that they were planning to create a further walkway within the grounds which would be accessible for wheelchair users and an additional seated area. Care Homes for Older People 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 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 benefit from being cared for by competent and caring staff team but incomplete recruitment records mean that people cannot be fully confident that they are being safeguarded. Evidence: Staff files viewed showed that generally staff recruitment is well managed with the necessary pre recruitment checks being carried out to ensure that staff are suitable to work with older people. References for one person who had worked at the home for several years were not available on their file. The manager stated that she always takes up references for all new staff but did not know why the references for this person were not on file. Staff told us that they had an induction when they first started working at the home which included working alongside an experienced colleague to make sure that they had all of the information that they need to do their job in the right way. Staff explained that they attend training courses such as food hygiene, safeguarding of adults, dementia care, infection control, wound care, equality and diversity, fire safety and moving and handling. The manager described the staff as very committed saying that they all knew the Care Homes for Older People Page 21 of 28 Evidence: people living in the home well. One member of staff told us one member of staff said we look after people as if they were our own relatives. Staff were observed during the inspection being attentive to peoples needs and offering sensitive support, for example checking whether people felt warm enough and offering them a blanket. In a recent survey conducted by the home a relative of one of the people who lives at the home described the staff as Friendly, patient and caring. Discussions with staff and observation during the inspection showed there to be sufficient numbers of staff to meet peoples needs and ensure that they received appropriate care and attention. Care Homes for Older People Page 22 of 28 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 home is well run in the best interests of the people who live there. Evidence: The registered home owners live in a property next to the home. The manager told us that the owners are very supportive and want the home to offer a high quality of care and accommodation to people living there. Records show that the manager carries out a number of regular checks and audits to ensure that people are receiving the care that they need and that the home is safe. These checks include checking accident forms, medication and equipment such as wheelchairs. The manager told us that the home carries out a satisfaction survey annually. The results were viewed and were generally very positive. One person who lives at the home commented A very well run home with good, caring staff. and said it is lovely living here. The manager had made notes on the survey forms to show actions taken Care Homes for Older People Page 23 of 28 Evidence: as a result of points raised. One relative commented that All issues raised are given full attention. There is a suggestion box in the hall of the main house where people can leave comments and suggestions. Records show that the necessary safety checks such as fire checks, checks on the water system and portable appliance testing have all been carried out recently. Hoists and lifting equipment has been serviced as per manufacturers recommendations. One member of staff commented that the home is run well - cannot fault it Care Homes for Older People 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 Older People 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 9 13 Medication records must be 28/02/2010 signed to show that medication has been administered and must have an audit trail which details the amount of medication held by the home. To ensure that people receive their medication as prescribed. 2 17 12 Where people are being 28/02/2010 supported to make complex decisions, such as whether to be resuscitated, records must show how their mental capacity to make such a decision has been assessed, and, where it is deemed that someone does not have capacity to make a decision and a decision has been made on their behalf, records must show how the decision was reached and how it is in the persons best interests. Page 26 of 28 Care Homes for Older People 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 To ensure that peoples rights to make decisions about their life are safeguarded. 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 27 of 28 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. 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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