Care Home: South Lodge

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What the care home does well South Lodge or Susan Day residential home as it is known locally, provides people with a well maintained, clean and homely environment. People who live at the home are proud of their surroundings and most commented on how well it was kept clean. Care and support is delivered in a planned way by a staff group who know and understand the needs of the individuals who live at the home. People we spoke to and those who returned surveys said ` The staff are darlings, very considerate and understanding, call bells are answered quickly. You are very free here you can come and go as you please. I am very happy here, staff are all very good to us. I had to have a tooth out and one of the staff was very gentle and kind to me.`` We received three surveys from health care professionals who all said that the home meet individuals needs very well. Comments included ``In nearly 20 years of visiting South Lodge I have never known their care or attention to differ from excellent, a statement I could not make of some of the other residential homes I visit.`` Excellent establishment, would be happy to go there as a customer.`` ``Caring approach to residents social and health needs. Have a good awareness of appropriate agencies to refer to if necessary.`` Activities and outings are offered to people and individuals are given opportunities to say what other activities they would like to do. Similarly people are given regular opportunities to have their say about the menus. People expressed a high level of satisfaction for the meals offered. There is always a choice of at least two options per meal and menus show that a good balanced diet is offered throughout the day. Staff have good training and this is reflected in the professional way they deliver care and support. The management of the home is open and inclusive and ensures that staff and people living at the home have their say about how the home is run and the quality of care delivered. What has improved since the last inspection? Plans of care have now been better organised and include more detail to enable carers to provide care in a consistent and person centered way. What the care home could do better: The home need to ensure that where records of medication is altered or handwritten, that this is double signed to help prevent any errors. The registered provider needs to look at ensuring that lighting in bedrooms is more domestic, currently most bedrooms have fluorescent strip lights, which although give off a strong light, they are not appropriate for bedrooms. Inspecting for better lives Key inspection report Care homes for older people Name: Address: South Lodge Susan Day Home Runnacleave Road Ilfracombe Devon EX34 8AQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joanne Walsh     Date: 3 0 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: South Lodge Susan Day Home Runnacleave Road Ilfracombe Devon EX34 8AQ 01271862528 01271862024 cherry@susanday.freeserve.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Trustees care home 33 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: Date of last inspection Brief description of the care home The Susan Day Home is a large voluntary-run home registered to provide care of up to 33 people over the age of 65 years, some of whom who may also have a dementia or mental health illness. The building is a three-storey Victorian villa situated in the Ilfracombe area of North Devon. Over the years it has had further extensions and adaptations to meet the needs of the people who live there. There is a lounge, dining room and two conservatories on the ground floor. Two further sitting rooms are sited on the first floor. All the private rooms are single and en-suite, apart from one room. Care Homes for Older People Page 4 of 27 Over 65 33 33 33 0 0 0 Brief description of the care home Residents have access to all areas of the home by a modern, large passenger lift. The home has an attractive outside area, with a front garden and a choice of seating in different areas available, including a summerhouse. The home is centrally situated in Ilfracombe and is within a few minutes level walk from local the shops, the sea front and quay. The range of fees can be obtained form the home directly. Chiropody, hairdressing, personal toiletry items and newspapers/magazines are additional costs which are not included in the fees. The latest CSCI inspection report is displayed in the front entrance hall of the home, with further copies available from the home upon request. 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: 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: This inspection took place during a week day in July and included two additional visits on 25th August and 3rd September to follow up on a complaint we had received. The focus of the inspection was to gain the views of the people who live at the home and individuals were spoken to during the inspection and care practice observed throughout the day. We also spent time talking to staff including the registered manager and assistant manager, 6 care staff, one cook and one domestic staff. We spent time looking at some of the key documents including plans of care, assessments, staff recruitment files, records relating to medications and individuals finances. This helps us to understand how well the home is run. The home had been notified that a review of the home was due and had been asked to Care Homes for Older People Page 6 of 27 complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. During the inspection 6 people were case tracked. This involves looking at peoples individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process we try ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to people living at the home; representatives, health and social care professionals (including GPs and care managers) and staff. At the time of writing the report, responses had been received from 9 people living at the home, and from 8 staff. Their comments and views have been included in this report and helped us to make a judgment about the service provided. We did not find any evidence to substantiate the anonymous complaint and this is discussed more fully in the main content of the report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New people are only admitted once the home have assessed their needs and feel able to fully meet those needs. Evidence: The pre admission information was looked at for two of the newer people to the home. The information gathered gave basic details of the individuals needs. The manager stated in the AQAA We always offer prospective residents the opportunity to spend a day (days) with us prior to making a decision to enter the Home, this is beneficial to them and also gives us the chance to assess their needs to be able to ensure that we can meet them fully. New residents are given a letter to this effect before entering the Home on a permanent basis. If a resident is too poorly to visit us we visit them and liaise with family and other professionals to ascertain their suitability for life with us. We always obtain as much information as possible from family, friends, social workers, doctors, district nurses to enable us to make an informed decision,assessments are always carried out by an Officer In Charge. On admission we write to the residents Care Homes for Older People Page 11 of 27 Evidence: doctor and ask for any information needed to help us to care for that person correctly, we also include a list of Homely remedies for them to give us permission to use. All residents have contracts which include the room to be occupied, overall care and services provided, fees payable, additional services to be paid for over and above those included in the fees, rights and obligations of service user and provider and terms and conditions of occupancy. Those residents paid for by Social Services have their contract as well as ours. All residents have an individual care plan which is reviewed regularly or when there is a change in their needs. Some individuals who we spoke confirmed they had visited the home prior to moving in and that they were asked about their support needs. Staff spoken to said that they were given information about any new people moving in, and those asked, appeared to have an understanding of the needs of people we case tracked. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals person and health care needs are very well met. Evidence: We case tracked five people during this inspection to help us understand the quality of outcomes for people. This means we looked at their plan of care, their medication records, talked to staff about how they meet their needs and where possible we spoke with the individual to see what their opinion was of how well their needs were being met. Plans of care were not well organised on our initial visit. They were held loosely in a folder and it was not always easy to find information quickly. Also some bits of the plan were not available and we were told that this may be due in part to the fact that it had not been printed off from the computer. The basic information held on each person gave details of their assessed needs and what staff should do to support them, but this needed further expansion to include individuals personal and preferred routines and how staff should meet these needs more specifically. We discussed ways in which the plans could be improved and by the following inspection visit to the home Care Homes for Older People Page 13 of 27 Evidence: work was underway to give plans of care a complete overhaul. This included putting the information into ring binder folders, having dividers to ensure that information for each person was easy to find and uniform. The plans were also moved to the staff office so that all staff had ready access to the plans. The new plans gave clearer details about how staff should meet assessed needs and also clearly identified any risks and what measures are put in place to minimise risks. There is a daily plan held in each persons room for staff to refer to in respect of how to meet daily personal and health care needs. The newer plans also contain more information about individuals social and diverse needs to help the home plan for these and to help staff understand the individual as a person with a past and history prior to moving into the home. People we spoke to were very positive about the care ans support they received and comments included The staff are darlings, very considerate and understanding, call bells are answered quickly. You are very free here you can come and go as you please. I am very happy here, staff are all very good to us. I had to have a tooth out and one of the staff was very gentle and kind to me. We received three surveys from health care professionals who all said that the home meet individuals needs very well. Comments included In nearly 20 years of visiting South Lodge I have never known their care or attention to differ from excellent, a statement I could not make of some of the other residential homes I visit. Excellent establishment, would be happy to go there as a customer. Caring approach to residents social and health needs. Have a good awareness of appropriate agencies to refer to if necessary. We had 9 surveys returned from people who live at the home and all of these had ticked always to the question does the home make sure you get the medical care you need? Comments included Always a pleasant atmosphere and all helpers and carers are cheerful and loving. Everything is done for us. The home does every thing as best as possible for us. We had eight surveys returned from staff and during the inspection we spoke with four staff members. They gave very positive responses to the questions about how well they felt they met individuals needs. The staff we spoke with and the practice observed showed a good level of understanding of the needs of frail older people. Staff were seen supporting people in a kind and respectful way throughout different periods of the day. Individuals we spoke with confirmed that their health care needs are well met with regular visits from the chiropodist, visits from their doctor when needed, support to go Care Homes for Older People Page 14 of 27 Evidence: to hospital appointments and visits from optician, physiotherapists and other allied health care professionals as needed. These are clearly recorded in peoples plans of care. The medication storage system and records were also looked at as part of this key inspection. We would recommend that any hand written entries into medication records are always double signed to help prevent errors. We would also recommend that if people are prescribed any PRN (as needed) medications, that clear instructions are included as part of the plan of care that include what steps staff should take before considering the PRN medication. Care Homes for Older People Page 15 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. Individuals social and diverse needs are well met. The home works hard to ensure that people are offered a balanced and varied diet to suit individuals preferences and wishes. Evidence: The home employs an activities coordinator who works most mornings and looks at what individuals enjoy doing and organises group and individuals one to one sessions to ensure that people are engaged and encouraged to join in and have some daily stimulation. Activities include things like bingo, quizzes, music and film sessions and trips out. Two staff have been on a course to be able to facilitate gentle exercise and chair exercises. Church services are also attended and local clergy will visit to give communion as requested. The introduction of a more comprehensive plan of care that includes more detail about individuals past histories and diverse needs will enable the home to gear activities even more to the wishes of people with live there. People we spoke to said that they enjoyed the activities and felt that the home offered them a good range of things to do. One person told us that they were always asked if Care Homes for Older People Page 16 of 27 Evidence: they wanted to join in and that the activities person was always shopping for any littles bits and pieces people needed. Individuals are asked during regular meeting what activities and menu choices they enjoy, if they would like to add or change anything and this is then followed up. People are offered a good range and choice of meals. The menus are developed to incorporate individuals likes and dislikes and special diets can be catered for. The main meal is served at lunchtime and there is always a choice of at least two options. People expressed a high levels of satisfaction about the meals. Surveys returned said that most people always enjoyed the meals offered. Only 2 out of 9 said usually to the question do you like the meals at the home? Comments included We are very well fed. I enjoy all the meals here, We are given variety of things and it is always hot and nicely presented. The main meal was served in an unhurried and relaxed manner, with individuals getting support in a discrete way. The home plays old time music as background and several people commented on how much they enjoyed this. One person said that there had been a dispute at their table, but staff quickly sorted this out and the person was moved to another table to enjoy their meal. People are able to have visitors at any time and refreshments are offered. Individuals are helped to stay in touch with family and friends via letters, phone calls, emails and regular social gatherings organised by the home to encourage family and friends to visit. Care Homes for Older People Page 17 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. Individuals views are listened to and acted upon. Evidence: The home has a stated complaints process and people we spoke to were aware of this and said they could make their concerns known. One person said that they were asked daily by senior staff and carers if they were happy and was there any thing that they needed, so they have no reason to complain. The home have had no formal complaints made over the last 12 months. The Commission received one complaint from an anonymous staff member who said that they believed that the management of the home was not inclusive and that plans of care had vital areas missing such as risk assessments. The complaint also said that some individuals may have been placed at risk by not using bed rails and by not calling for emergency treatment for someone in good time. We went back to the home for a second inspection visit to look at some of these concerns, particularly in respect of people being placed at risk. We did not find any evidence to substantiate the complaint issues. We saw that staff meetings minutes were available and that it was minuted that staff were asked if they wanted to raise any issues. We saw the care plan and records for the two individuals who the staff member said could have been placed at risk. We did not find this to be the case. The individuals records showed clearly that risk assessments were in place and that medical treatment had been sought for falls. Care Homes for Older People Page 18 of 27 Evidence: Staff told us they have training in the protection of vulnerable people and when asked knew what they should do if they suspected abuse. Policies and procedures are in place to ensure that individuals rights are protected and staff understand their roles. Care Homes for Older People Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. South Lodge or Susan day home as it is known locally, provides people with a very clean homely and pleasant environment that is safe and well maintained Evidence: During this inspection we saw all communal areas including the kitchen and laundry, and some of the individual bedrooms. The home employs a small team of domestic staff who are commended for their efforts in keeping the home cleaned to a high standard and fresh smelling. Many of the people we spoke to and those who returned surveys commented on the fact that the home was kept clean and all ticked always to the question is the home fresh and clean. The AQAA states On the left-hand (museum side) of the building the fire exit steps and walkways have been renewed. All of the Parker Knoll armchairs (six in total) have been professionally re-upholstered. We consulted residents when considering replacing the chairs but honoured their overwhelming demand to keep them as they are so comfortable. Four more chairs in our main lounge are being re-upholstered next month. We consulted the Physiotherapist on this who commented that the chairs are exactly the right height. The home has policies and procedures in place for infection control, including a policy on flu pandemic. Staff were seen to follow good infection control procedures using Care Homes for Older People Page 20 of 27 Evidence: gloves and aprons appropriately. The laundry is well organised and all bed linen is sent out to a commercial company for laundering. One area that we recommend should be improved is the lighting in individuals bedrooms. Currently most bedrooms have fluorescent strip lighting, which is not domestic in use as recommended in the national minimum standards. The home should look to change these to more suitable bedroom lighting, with additional spot lighting for those who require it. Care Homes for Older People Page 21 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. Staff are well trained and supported to do their job Evidence: The staffing levels appear sufficient for the number and needs of the current people living at the home. There are normally four care staff on during the morning shift and three on during the afternoon. There is also a manager and usually an officer in charge, plus a cook, kitchen assistant and three cleaners. The home also employs an activities coordinator most mornings. Staff spoken to and those who returned surveys said that they were well supported and had good opportunities for training. Comments included provides up to date training to enable me to meet the needs of people I care for. Also provides regular supervisions and appraisals for me to discuss any issues that I may have Staff recruitment records supported the views of staff, and showed that training was offered on a regular basis and covered all aspects of health and safety, as well as some more specialist areas of caring for the particular needs of people that live at the home. Three staff recruitment files were seen and showed that robust procedures were in place and people were only employed once they had been cleared as suitable to work with vulnerable people. 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 excellent 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 managed and run in the best interests of the people who live there. Evidence: The registered manager is qualified and has many years expedience of running a home. She understands the needs of the people the home provides a service for and can demonstrate that she continues to update her knowledge and training. Staff spoken and those who returned surveys said that the manager was very inclusive and there were opportunities to have their views heard. One staff member made a complaint to the Commission and an element of this complaint was that the management of the home did not listen. We could find no evidence to support this. On the contrary, we saw that she constantly looked for ways to ensure that staff and people who live at the home have their views heard via meetings and having an open door policy. The home have good quality assurance processes in place to ensure the views of Care Homes for Older People Page 23 of 27 Evidence: individuals who live at the home, their families and other stakeholders are all able to make their views known. This helps to plan for improvements in the quality outcomes for people. We saw that regular meetings are held for staff, for people who live at the home and for their families. We also saw that surveys are used to gain views. The registered provider ensures that they visit monthly and provides a report on what has been audited. The AQAA also gives us information to show how the home ensures safe working practices via training and policies and procedures. We saw that all new staff have an induction programme that meets national standards. We checked the system in place for ensuring that any personal monies kept is safe and accountable, and found that a good audit trail is available and records well maintained. 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 1 19 The home should look to make bedroom lighting more domestic in nature and remove fluorescent strip lights. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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