Care Home: Trepassey

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What the care home does well There is a variety of different places in the home for people to spend their time. The environment available to people who live in the home is pleasant and in keeping with decoration found in people`s own homes. The staff team supports individual choices as to where they would like to spend their day. Staff have an understanding of people`s individual preferences and communicate these to each other well. People living in the home believe that any concerns they have will be addressed. They told us "I have absolutely no complaints, the staff are fantastic. If I did they would take me seriously and I`m sure they would be very upset" and "whenever I have had a problem the manager made sure that it was all sorted". Information that tells people about the services that Trepassey provides is easily available. Copies are available in the main foyer of the home and also given to people when they move into Trepassey. What has improved since the last inspection? The instructions to staff on how to support people called care plans have been improved. when a person living in the home has a need identified, most of the time a care plan is put into place to tell staff how best to meet that need. What the care home could do better: Instructions to staff need to be clearer. Information needs to be available to staff as to when to give "as needed" medications and what external preparations such as creams are to be used for. Care plans were not individual and were not always kept fully up to date. Staff did not always support people appropriately at mealtimes. The did not make sure that someone was available to help people living in the home and did not provide specialised cutlery to help maintain people`s independence. Staff training and recruitment records were not kept up to date. Staff in the kitchen and undertaking domestic duties did not have records that showed that they had been recruited correctly. This had previously been available but had not been included in staff files shown to us. Several staff were in need of health and safety training such as moving and handling that they would need to maintain their own safety and the safety of people living in the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Trepassey Hillside Road Heswall Wirral CH60 0BW     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: Julie Garrity     Date: 1 9 0 2 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 26 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 26 Information about the care home Name of care home: Address: Trepassey Hillside Road Heswall Wirral CH60 0BW 01513422889 01513427031 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cheshire Residential Homes Trust Name of registered manager (if applicable) Mrs P Lucas Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC 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 The maximum number of service users who can be accommodated is: 24 Date of last inspection Brief description of the care home Trepassey is a care home that provides personal care and accommodation for up to twenty four people with an age related conditions. The home is owned by a registered charity, the Cheshire Residential Homes Trust and was opened in 1958. Trepassey is a three storey detached house set in its own gardens with access to a level patio area at the front of the building. There is parking available to the front of the building. All bedrooms are single and have an ensuite toilet or shower / toilet facilities. Bedrooms are located on each floor. Communal accommodation within the home consists of two lounges, dining room, reception hall and a sunroom. There is a passenger lift that Care Homes for Older People Page 4 of 26 care home 24 Over 65 24 0 Brief description of the care home serves all floors and mobility aids are available. The service is no smoking throughout an outside space is availiable for people to smoke in should they wish. The fees for people wishing to live in the home start at the local council rate of 484 pounds and depend on individual assessed need. Additional fees are charge for specific personal items such as newspapers and personal toiletries. Information about the last visit we made is available in homes main foyer and included in information given to people wishing to move into the home. Trepassey is located in a quiet area of Heswall and benefits from views across the River Dee estuary across to Wales. The town centre is less than a mile away and a bus service passes the end of the road. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The visit was carried out over a period of one day. We arrived at the home at 11:15 and left at 19:15 the visit was a total of 9 hours. We looked at all areas of the home including six of the bedrooms of the people who live in the home. People who lived in the home and their relatives were offered the opportunity at the visit to discuss their opinion of the care and support provided. On this occasion we spoke with eight people who live in the home, six members of staff, two relatives and the manager. Additionally ten questionnaires sent to people who live in the home and staff. The manager told us that they had received and return surveys for staff but had not received any for people who live in the home. The service was sent an Annual Quality Assurance Assessment known as an AQAA. This asks them to let us know how they have improved the quality of the service that they provide in the last 12 months. Care Homes for Older People Page 6 of 26 A number of areas of support were reviewed and this involved us looking at records such as how the staff found out peoples needs and care plans that showed how they plan to meet their care needs. We also reviewed the health and safety arrangements to maintain safety such as managing medications and identifying and reducing any risks. Observation of how the staff provide care and support was also undertaken. We reviewed the training, support and monitoring of staff skills. Feedback was given to the manager throughout the visit and at the end of the day. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the staff in Trepassey used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. 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. 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 8 of 26 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 9 of 26 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 wishing to move into the home are given the information they need to decide if Trepassey can meet their needs. Evidence: We looked at the care records of three people living in the home. These showed that all people wishing to move into Trepassey had assessments (a review of peoples needs) carried out before they move into the home. The assessments were used to determine if the staff can meet the individual needs of the person wishing to move in. Staff told us that were informed about new people moving in and told what their basic needs are so that they can meet their individual needs. The AQAA from the home told us that they invite people to visit the home and have tea or coffee with us. People living in the home told us my family chose the home for me and I knew about this place. I had visited friends in here over the years so I Care Homes for Older People Page 10 of 26 Evidence: thought it would be a nice place to live. The information in the home know as a statement of purpose (Trepasseys statement of its services) and a service users guide (information to people as to how they will deliver the service), told us that people were offered an opportunity to visit before they move in to see if Trepassey will meet their needs. We looked at the information that the home gave to people to help them decide if the home could meet their needs. This was in need of updating and needed to include information such as staff numbers and skills as an example. We spoke with people living in the home one of who told us, We did get some information when I moved in. I looked at it at the time but to be honest Ive never really bothered since. Copies of the service users guide was available in the main entrance of the home for visitors. All the people living in the home were given a copy of the service users guide before they moved in to help them decide if the home could meet their needs. Care Homes for Older People Page 11 of 26 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 living in the home have their health and personal care needs meet. Evidence: We looked at how people were supported in getting their medications. This showed that all people living in the home received their medications in a safe manner. All but one person received their medications as prescribed. One person had run out of a medication and none had been order. This meant that this person did not have the medication available that they needed. There were some minor documentation areas that do not maintain good practice. This included a lack of clear instructions for some medications such as when needed and external medications such as creams. Good instructions need to be available at all times to make sure that staff can give medications correctly at all times. The AQAA for the care home told us that the home,provides individual care plans. We looked at care plans and noticed that each person had their own plan of care. We sampled three care plans, in all but one case an assessed need had a corresponding Care Homes for Older People Page 12 of 26 Evidence: care plan with instructions to staff as to how to meet the persons needs. One person had returned to the home the day before our visit. The persons care plan had not been updated to reflect their changed needs. We also noticed that some of the care plans were photocopies and were identical plans for different people. This meant that they were not specific to each person. The instructions available in the care plans were not specific as to how to meet the persons individual needs. Examples of this included, assist with hygiene, this did not tell staff what they needed to do to meet that persons hygiene needs. We spoke to people living in the home and their relatives about their care plans. They told Not sure what you are talking about, Staff are very good Im sure they know what they need to do and I think we did when she first moved in but not seen anything since. It is good practice to include the people that the service is supporting in writing care plans or their representatives. This helps verify the accuracy of any information and for the people living in the home to say what is important to them. When we looked at how the service accessed external professionals such as doctors or dietitians we found that in all cases the staff had recognised changes in peoples needs and contacted the relevant expert. Care Homes for Older People Page 13 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home are flexible to meet individuals choices. Activities and meal times support are not sufficient enough to meet peoples needs, preferences and choices. Evidence: The AQAA from the home told us that they provide entertainment of choice. They also told us that they could offer more entertainment. We spoke with people who lived in the home who told us they would like more outings, and theres nothing going on this afternoon. The manager told us that they held regular meetings, the minutes of the meetings showed that several of the people living in the home wanted more activities and trips out. Information to people living in the home about activities is not in enough detail to inform them of their choices or meet their needs. There are menus available to tell people who live in the home about the food that is available. The menu shown to us did not identify special diets such as vegetarian or diabetic. Special diets need to be identified in order to support people who need a special diet to choose food that meets their needs. The menus did show a choice of meals. We spoke to the kitchen staff who told us that they are happy to cook Care Homes for Older People Page 14 of 26 Evidence: additional choices such as omelettes if the person does not like what is on offer. People spoken with had varying opinions of the food including lovely, tasty, bland, always the same things, dont like the food, eat what you are given and nice food, I enjoy it. People who live in the home have their weight monitored and anyone losing weight is referred to a dietitian. We observed one person over lunch time struggle to eat. They were unable to use the cutlery provided and needed a softer diet. The staff did cut up the food and obtained more suitable cutlery when prompted to do so. A variety of main courses were served by staff and dishes were placed on the tables with vegetables to encourage the people living in the home to be independent. Once the staff had finished serving they left the dining room unattended with no staff in place to assist if anyone needed it. The manager told us that she had discussed this with staff on several occasions as she did not think it was a good idea and that at least one member of staff should remain to assist people if needed. All the people spoken with told us that their daily routines were pretty much of their own choosing they were aware of when meal times are and what they could do to influence their own days. They told us that they generally get up and go to bed as they want, one person told us, stay up as late as you want to, get up when you want to, have a sleep in the afternoon if you feel like it.. Visitors are welcome at the home. We spoke to a visitor who told us that I feel happy leaving my mother here. Staff welcome me whenever I visit. Care Homes for Older People Page 15 of 26 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 feel that their concerns will be taken seriously and dealt with. A lack of training for all staff means that not all staff will be aware of how to fully safeguard the people they support. Evidence: People spoken with where confident that they where able to express any concerns and that these would be addressed. We spoke with two people living in the home who told us, I have absolutely no complaints, the staff are fantastic. If I did they would take me seriously and Im sure they would be very upset and whenever I have had a problem the manager made sure that it was all sorted. The AQAA from the home told us that a complaints procedure is available in each persons bedroom and in the main entrance to Trepassey. When we looked around the home we noticed that there was a copy of the service users guide in each bedroom. This did contain a copy of the complaints procedure and informed people of how to raise concerns and what the service would do to fix any concerns. The manager records any concerns raised, in the care records of people who live in the home and in a complaints file. They have received one concern since our last visit. This was initially dealt with by social service. The manager kept records of this to make sure that they improved the quality of the service in light of the concern. Care Homes for Older People Page 16 of 26 Evidence: Not all staff have received training in the protection of adults from potential abuse. The kitchen and domestic staff have been transfered to a private company. The staff we spoke with employed in this area had not had training in the recognition, prevention and reporting of potential abuse. The care staff had received training in the last eighteen months. Those spoken with had a reasonable understanding of how to report concerns and the ways in which an allegation of this nature would be dealt with. A policy and procedure is also available to help guide staff should serious concerns occur. Care Homes for Older People Page 17 of 26 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. Ryecroft is well maintained and presents a nice, pleasant and hygienic place for people to live in. Evidence: A tour of the home was undertaken and a sample of bedrooms seen. The people living in the home told us, its a beautiful house with beautiful views and its a really lovely building, I would like to be able to paint but my room is too small. I suppose I could us a bit of the conservatory. Relatives told us the home is always clean and tidy. The staff are always working hard to make it look nice. Trepassey was decorated in a style similar to a persons own home and attempts had been made to keep it homely with pictures etc. The AQAA for the home told us that they have redecorated, refurbished and changed the carpets in several rooms in the building. There was evidence of ongoing decoration to maintain standards at the home. The dining room and the lounge have been swapped and this helps give the people who live in the home a choice about were they would like to spend their time. Peoples bedrooms were viewed. They all had items that the people who lived there had brought in from their own homes such as pictures and odd items of furniture. One person showed us around their room and told us I really love the view from the window. Its fabulous in the summer time. Care Homes for Older People Page 18 of 26 Evidence: The kitchen is located on the ground floor near the dinning room. A full cleaning schedule was available for the staff and the kitchen was clean and well maintained at the visit. The laundry is situated on the first floor of the home. A washing machine and tumble dryer were contained within a very small room. Although a system had been put in place to suit the facilities available, which includes using an outside cleaning service for the cleaning of bedding and towels; this is a very small space for staff to work in. Plans to extend the home to provide a larger laundry area and further storage facilities are being looked at. Staff had received some training in maintaining hygiene levels such as food hygiene and infection control. Not all staff have received this training and as such were not fully aware of the ways to prevent the spread of infection. Observations over the day did show that staff appropriately used protective equipment such as aprons and gloves during the day. This practice helps prevent any potential infections spreading. Care Homes for Older People Page 19 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training and checks on their suitability to work in the home are not sufficient to make sure that they can maintain the safety of the people living in the home. Evidence: On the day of the visit there were several members of staff available in the home. People living in the home told us there are lots of staff about when you need them. Staff were observed during the visit to be calm and unrushed. Staff took their time to support people who live in the home at a pace that suited the persons needs. The AQAA for the home told us that there is a, thorough training programme. Care staff spoken with told us that they had received training. Records of training showed that not all the staff were up to date with the correct training in particular moving and handling. The manager told us that this will be organised in the next few months. In most cases staff had up to date training, in some cases staff training needed to be updated. The manager monitors the practices in the home to make sure that staff are competent in their job roles. Training such as moving and handling and fire safety for some staff members needs to be updated as this can place both people living in the home and staff at risk. Staffing files were reviewed and detailed that all the care staff had the relevant checks Care Homes for Older People Page 20 of 26 Evidence: of employment, such as police checks, references and a check that they are suitable to work with older people before they started working. When we looked at the kitchen and domestic staffs files we were unable to find references, training records, police checks and application forms. The manager informed us that staff in the home had transferred to the private training company and at that time they had all those checks in place. Training for kitchen and domestic staff was out of date they had no recent moving and handling training and no protection of vulnerable adults training. All staff need to have up to date training in order that they can maintain their own safety and that of the people that they support. Care Homes for Older People Page 21 of 26 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 management of the home makes sure that the home can safeguard the people who live there and support the staff to undertake their job roles. Evidence: Some small amounts of money were held on behalf of the people living in the home. The service does not have a legal responsibility for any of the funds of the individuals they support. Receipts are kept for any spending or money given the service by relatives. A float is available at evenings and weekends in case any of the people living in the home want some of their money. There were arrangements for obtaining the views of people who live in the home and their relatives such as meetings and questionnaires that are regularly sent out. Minutes of meetings were available that showed activities had recently been discussed with people living in the home. The information from these did have some influence on the running of the home such as activities and menus. Care Homes for Older People Page 22 of 26 Evidence: The registered manager has many years experience within the care sector. She is a Registered General Nurse (RGN) and has an NVQ level 4 in management (a qualification specific for managers of care homes). There were policies and procedures in the home that also include aspects of equality and diversity such as harassment and equality of opportunity. The majority of policies and procedures were up to date and covered areas of best practice that staff needed to be aware of. These were available and discussed with new staff when they start in order for them to have proper guidance. The training records showed that many of the staff are provided with training around safe working practices. This was not the case for all staff particularly those working in the laundry and the kitchen. The AQAA for the home told us that that all appropriate documentation for safe working practice is kept up to date. Maintenance certificates for gas, electricity and equipment in the home were all up to date. The fire systems were regularly checked and any issues were identified and fixed. The home has fire risk assessments and general environmental risk assessments. These have been recently reviewed in order to maintain the safety of people living in Trepassey. Care Homes for Older People Page 23 of 26 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 24 of 26 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 7 Care plans need to be reviewed in order to make sure that they provide staff with up to date, clear instructions on how to meet peoples individual needs. The policy and procedure for medications needs to be reviewed. Staff need to make sure that they follow the correct policy and procedure at all times. Medications that are on a per required need basis need to have clear instructions. Audits that look at practice need to be consider in addition to the current weekly drugs count. A review of menus and activities needs to be undertaken to take account of individual preferences and needs. This information needs to be easily available to the people living in the home. 2 9 3 13 Care Homes for Older People Page 25 of 26 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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