Care Home: The Field House

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What the care home does well People were happy with the care that they received in the home. One person said "I am grateful for the service and friendship I receive." One relative said "The attention and care (my relative) receives is excellent." People are seen by a senior member of staff before they are admitted and good information is collected about their health and social care. This helps the home decide if they can meet the person`s needs. People in this home are given their medication as prescribed and general information about health conditions is kept to staff to look at. This helps to ensure people keep healthy and staff are knowledgeable about conditions that affect people. People thought the food in the home was good. People are given the choice of food at all mealtimes. One relative said "Meals are prepared so that my relative can easily digest them." The home is clean, fresh and comfortable and this makes it a pleasant place to live. The home recruits and trains staff well and this helps to keep people in the home safe. What has improved since the last inspection? Since the last inspection care plans and risk assessments are completed in a more timely way. This means that staff are given the information about how to care for a person as soon after admission as possible. Every month an interim care plan is written and this gives staff information in a way that it can be read quickly. Staff can write any changes in the persons`s needs or ability on the interim care plan and this if necessary changes the main care plan. Complaints, compliments, and minor irritations raised and how they have been resolved are recorded. This helps the home look for any trends of dissatisfaction. People living in the home were telling the manager about small issues and this means that they feel safe to do so. There have been many improvements to the environment sice the last inspection including, the new carpet in the dining room, thermostatic valves on some hot water outlets, and the kitchen has had new storage cupboards. The home was decorating one of the dining rooms at the time of the inspection. What the care home could do better: The home keeps daily records of what is happening to people during the day, these records do not give much detail other than people have eaten and moved from room to room. These do not indicate that people have positive experiences. Although people have care plans, more needs to be done to ensure that people have individual activity plans. People said "there is not much entertainment." "I think trips out would be beneficial to residents from time to time." Residents meetings showed that there was some difficulty in getting agreement about activities.Staff sometimes walked through the kitchen without appropriate aprons and this could be an infection control risk. The staffing levels of the home are appropriate however when people become ill or staff are off work staffing levels are strained. We found that there was not as much monitoring of the service as required and this could mean that shortfalls are not identified quickly. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Field House 110 Harborne Park Road Harborne Birmingham West Midlands B17 0BS     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: Jill Brown     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: The Field House 110 Harborne Park Road Harborne Birmingham West Midlands B17 0BS 01214263157 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) : Park House Care Ltd care home 21 Number of places (if applicable): Under 65 Over 65 21 old age, not falling within any other category Additional conditions: 0 That a minimum of 2 care staff are on duty at all times with additional ancillary & support staff as necessary to meet the needs of the service users That the manager completes the Registered Managers Award and supplies a copy of the certificate to the Commission by 31st August 2006. The home is registered to accommodate 21 OP Date of last inspection Brief description of the care home The Field house is a privately owned residential home for 21 older adults. The home is a Georgian house built in 1760 and retains some of its original features and appearance. Care facilities are provided on three floors and all areas can be serviced via a passenger lift. All rooms are for single occupancy and fourteen of these rooms have en-suite facilities. There is a split-level lounge, two dining rooms, and kitchen and laundry facilities on the ground floor. The home has pleasant gardens and a swimming pool in the grounds. The home has a separate hairdressing salon. The home is within a short walking distance of Harborne High Street and is on a main bus route. The fees Care Homes for Older People Page 4 of 29 Brief description of the care home for the home are between £1570 and £2200 per calendar month dependent on size of room and facilities. People funded by social services will have to find a top up. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home without notice on a day in June 2009 and undertook a key inspection where we looked at the majority of the national minimum standards. The home last had a key inspection in June 2008. Home gave the information in an Annual Quality Assurance Assessment (AQAA) before the key inspection. The AQAA shows how the home rates their performance in areas set out in the report. During the inspection three peoples care were case tracked, this involves looking at all the records about these people and how the home manages their care. We spoke to them or observed their care. We spoke to 2 relatives, 2 staff and the manager. We also Care Homes for Older People Page 6 of 29 received 4 comment cards from people that lived in the home and 2 from relatives. We looked around part of the building and the health and safety checks that have been undertaken. We received no complaints about the home before we inspected. What the care home does well: What has improved since the last inspection? What they could do better: The home keeps daily records of what is happening to people during the day, these records do not give much detail other than people have eaten and moved from room to room. These do not indicate that people have positive experiences. Although people have care plans, more needs to be done to ensure that people have individual activity plans. People said there is not much entertainment. I think trips out would be beneficial to residents from time to time. Residents meetings showed that there was some difficulty in getting agreement about activities. Care Homes for Older People Page 8 of 29 Staff sometimes walked through the kitchen without appropriate aprons and this could be an infection control risk. The staffing levels of the home are appropriate however when people become ill or staff are off work staffing levels are strained. We found that there was not as much monitoring of the service as required and this could mean that shortfalls are not identified quickly. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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 information that helps them to make a decision as to whether to move into the home. Peoples needs are fully assessed by a representative from the home. This means the people using the service can be confident their needs will be met. Evidence: At the last key inspection the information provided to people before they were admitted to the home was judged as sufficient for people to make a choice about whether the home would suit them. The homes Annual Quality Assurance Assessment stated that this information was reviewed regularly. We did not look at this information on this inspection. Peoples records had a copy of their contract and this included information about the Care Homes for Older People Page 11 of 29 Evidence: level of fees and any top up payable. This helps people understand the terms and conditions of their stay in the home. Only one of the people admitted recently was still in the home and we looked at the details of their admission. The manager took information from the persons previous placement about the persons health and personal care needs and added to the information following a visit to the person before their admission to The Field House. Information was collected about how the person viewed their care needs. A care plan was written on the day of admission and risk assessments were completed on that day or the day after. This quickness helps to ensure that staff have appropriate information to deliver the care in the way needed and wanted and risks to the person are minimised. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have care plans and risk management plans that are detailed enough to ensure that staff know what care people need. People have their healthcare needs met. Medication records showed us people using the service receive their medication safely and this helps to keep them well. Evidence: We looked at the care plans, risk assessments and care given to three people including a new admission to the home. All three people had information about their health conditions, personal care needs and risks to their well being. Care plans showed how people needed assistance, what they could manage themselves and how they communicate with people. This information helps staff maintain peoples skills and independence. Risk assessments were Care Homes for Older People Page 13 of 29 Evidence: undertaken for risks such as the likelihood of people developing pressure areas and falling and plans were developed for how these risks can be minimised. Attention was paid to any identified health conditions, general information about these conditions was available in the file and there were plans in place to inform staff of any symptoms they may need to look for that may indicate the person is unwell. Interim care plans have been put in place. These show what staff need to do to give appropriate care. They are a shortened version of the care planning and risk assessments and allow staff to get information quickly. In addition to this staff are encouraged to write on them if they have noted that something is working well or not working well. These comments are then looked at, at the monthly review of the persons care and the main plan will be changed if necessary. This is good practice as it helps plans to change as a persons needs change. Medical appointments were recorded in all three care plans. They showed that people received visits from health professionals when needed. People after admission received visits from opticians, chiropodists and dentists if these hadnt happened for some time. Regular visits were set up with these professionals subsequently. Daily records were kept but these did not show what people were engaged in during the day. We talked to two staff and discussed the care of a person that we were case tracking. Staff knew the care the person needed, their current health difficulties and how to move the person safely. Observation showed that people were assisted from place to place well and interactions between staff and people living in the home were good. We looked at the medication administration for three people living in the home. We found that medication was ordered and it mostly arrived in a monitored dosage system. This means that the pharmacist puts medications for a person in a cassette according to the time the person needs to take it. This helps to ensure that people have all the medication they need at the right time. We also looked at medications that cannot be put into this system. We found that medications had been administered well, records were completed at each administration and this means medications in the home could be accounted for. People spoken to said that they were happy with their care and they got the assistance they wanted when they needed it. A person stated Im grateful for the service and friendship I receive. We spoke to staff about the maintenance of peoples privacy and dignity and found that staff were able to tell us how they would practically ensure that people views in this area were respected. Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are able to exercise choices over their daily routines and are offered activities. This helps people become involved with the home. A wholesome and varied diet is offered and people who have specialist needs are catered for and this can improve their health. Evidence: We looked at the activity records for people for May and found that not all activities were recorded. Records suggested that people were involved from between two and six activities per month. The homes Annual Quality Assurance Assessment states that they continually address the issue of activities with residents. We found that at resident meetings in October, November and December activities were discussed with people and there was some difficulty in gaining agreement on the type and time of activities people wanted. Some people went out for meals. Staff said that people are encouraged to do arts and crafts, play bingo, quizzes, have foot spas and chat. We spoke to people who said, I dont go out, I dont want to go out. There is not much entertainment, the television is on but it get on my nerves. We have a dog that comes Tosca I like that. The home has had a petting donkey visit also. I think that Care Homes for Older People Page 16 of 29 Evidence: trips out would be beneficial to residents from time to time. There was not enough individual planning of activities based on past and present interests and group activities are not working for a number of people. Relatives are encouraged to visit people living in the home. Relatives said:- the staff are always welcoming to visitors and staff very kind nothing too much trouble. People living in the home have the option of where they spend their time either in their rooms or in the communal areas of the home. People spoken to said that they were able to get up and go to bed when they wished. People spoken to thought the food was good. A person admitted to the home had increased in weight and been encouraged to eat a wider variety of food than they had been used to in recent times. People have the option of a hot meal for breakfast, main meal and tea. On the day of the inspection people were observed having eggs on toast, cereal, toast and or porridge for breakfast. For lunch people were offered a roast chicken dinner and those who did not want this were offered alternatives. People were observed having fish in batter, fish in white sauce or a pasty. Menus provided showed that people were offered a traditionally English menu. We talked to the cook who was aware of the dietary requirements of people living in the home. A comment card said meals are prepared so that my (relative) can easily digest them. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident their complaints and irritations will be listened to and responded to. This helps to ensure that people feel that their views matter. People are safeguarded by staff that are recruited appropriately and are trained to understand what may put them at risk. Evidence: We have had no complaints about the service and the homes Annual Quality Assurance Assessment states that they have had no complaints. The home collects together comments people make, minor irritations about the service and actions they have taken and compliments are recorded. This assists the home in ensuring that people feel that views are listened to. We looked at the record and found that people made comments both positive and negative about food and advised the manager about small items of repairs that were needed. There have been no allegations of a safeguarding nature since the last inspection. The manager has made appropriate referrals to the appropriate agencies when there have been concerns in the past. We spoke to staff about how they would safeguard people in the home. Both staff would report concerns to the manager. Staff have had training in safeguarding and this helps to ensure the safety of people living in the home. Care Homes for Older People Page 18 of 29 Care Homes for Older People Page 19 of 29 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. People in this home live in a secure, clean and comfortable environment and this promotes their health and well-being. Evidence: Since the last inspection there have been improvements to the environment and these are continuing. The carpets in the dining areas have been replaced and one of the dining areas was being refurbished at the time of the inspection. The kitchen has been upgraded with the kitchen units being replaced and these are now more easily cleaned. The Annual Quality Assurance Assessment (AQAA) said that rooms without hot water restrictors have now been fitted. New blinds have been fitted in the lounge. The home was clean and fresh and there were no unpleasant odours. The AQAA states in the next 12 months they intend to refurbish 2 en suites into wet rooms and continue the redecoration and refurbishment of bedrooms. The bedrooms are of different sizes and shapes and offer different facilities. People are able to personalise their room by bringing in items important to them. The kitchen was clean and food was appropriately stored. The majority of staff have completed a food hygiene course. Bathrooms were clean both in communal bathrooms and en suites looked at. It was noted at the time of the inspection that a number of Care Homes for Older People Page 20 of 29 Evidence: staff came through the kitchen without appropriate aprons. The layout of the building makes this more likely and some procedure of how this can be managed needs to be developed. Care Homes for Older People Page 21 of 29 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. Whilst there are enough staff to meet the needs and wishes of people in the home when peoples needs change the review of staffing levels needs to be undertaken. People in this home are protected by staff that have a good level of training. Evidence: We looked at the rotas provided by the home and found that there are usually two care staff working in the morning and in the afternoon. In addition to care staff the home is supported by a cook daily and housekeeper from Monday to Friday. The managers hours and not always in addition to the care hours provided and this could make it difficult for all the managers tasks to be completed. People said that they appears to be enough staff except when people living in the home become ill or that staff are suddenly unavailable. The homes Annual Quality Assurance Assessment stated that 70 staff have achieved a National vocational qualification level 2 in care. This means that the majority of care staff have had training about how to care for older people. We looked at three staff files. Recruitment records sampled showed that appropriate checks had been made to make sure that staff were suitably experienced and qualified Care Homes for Older People Page 22 of 29 Evidence: to work with vulnerable adults. Criminal Records Bureau checks had been made and written references received before the employee began work so that people were protected from the risk of having unsuitable staff work in the home with them. One staff member had to have further evidence about their ability to work above a set number of hours. We looked at the matrix of staff training and noted that staff administering medication had the appropriate training. Staff have had training in mandatory areas such as fire, moving and handling and abuse. The managers stated that they were looking to commission further training in dementia, the mental capacity act, deprivation of liberty and emergency first aid. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of this home attempts to ensure that the home is run in the best interests of the people living there and has improved the collection of peoples views. Although there are some monitoring systems, this does not cover the whole of the service provided. The service providers are not undertaking their monitoring role. This means that issues could develop that are not identified quickly. Peoples money is managed well and health and safety issues are dealt with appropriately. Evidence: The manager has worked at the home for many years and relatives spoken to said that she was always willing and eager to discuss any changes in their relatives health conditions. The collection of peoples views in compliments and grumbles suggest that the manager is approachable. Care Homes for Older People Page 24 of 29 Evidence: People living in this home can raise issues that they are concerned about and act as a monitor for small immediate repairs such as replacing light bulbs. The home holds regular meetings with the people that live there to ask them about their views of the service provided. The manager had started work on an extensive quality assurance system related to the current national minimum standards. We have suggested as the legislation is likely to change that she adopt an audit approach to determining quality until the new regulations are in place. We noted that the owners had not visited the home for some time and had not completed a report of their monthly required visit. Visits by providers are part of the homes quality assurance system and they should be part of the planning for future improvements. We looked at the system used in managing peoples money and looked at the records for three people. We found that people are assisted to manage their money in different ways according to their needs. Some people have their money managed by relatives, and money is sent in for their immediate needs or the home meets the needs and recharges the cost later. There are appropriate number of records to show how peoples money is spent, people that are able signed their records and receipts are kept of any spending. The manager has seen staff on a daily basis and informs them about changes in routine. However formal supervision is not being completed routinely and this needs to be done so the staff have the opportunity to disclose concerns, have their performance managed and to be developed to work as well as possible. This can affect how people living in the home are treated. We looked at a selection of health and safety and maintenance records and found that these were in place. This means that people can be assured that the appropriate checks of the building and equipment are undertaken and this helps to keep people safe. Care Homes for Older People Page 25 of 29 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 26 of 29 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 26 13 (3)The home should look at methods of ensuring that the access to the kitchen is restricted to those wearing the appropriate gloves and aprons This is to ensure that the risk of transfer of infection is kept to a minimum 27/07/2009 2 33 26 The service providers must visit the home monthly, talk to staff and people living in the home and prepare a written report. This is to ensure that they form an opinion of the standard of care being provided in the home. 27/07/2009 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 29 1 2 8 12 Daily records should be improved so a fuller picture of the persons day is recorded. More individual planning of social activities especially when people are admitted should be undertaken so that people maintain their social lives. The manager needs to ensure that staff receive regular, recorded supervision at least 6 times a year. 3 36 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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