Care Home: Westfield Care Home

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What the care home does well Care plans are well documented and well organised with clear action to inform staff how they should deliver care to the individual. We found the staff to be very friendly and helpful and the people living in the home that we spoke to said that the staff were very good and always listened to what they had to say. One person said, `We are like one big family`. The home has robust recruitment procedures which means the required safety checks are carried out on staff before they commenced working at the home. What has improved since the last inspection? People living in the home have regular meetings where they discuss issues about the home such as meals and activities. The minutes of the meetings clearly showed what action the manager had taken as a result of the issues raised. We spoke with a person living in the home and they said that there were activities in the home and staff that we spoke to said that the activities organiser worked every day during the week and did individual activities with people such as baking, games, trips to the local pub and shopping in town. What the care home could do better: We looked at the medication systems in the home. We found that the systems were organised but we also found some gaps in the administration. We received information that there are sometimes problems with laundry items going missing and there had been an occasion when a person living in the home was wearing someone Else`s clothing. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westfield Care Home Devon Drive Mansfield Nottinghamshire NG19 6SQ     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: Lynda Dyer     Date: 1 9 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for 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: Westfield Care Home Devon Drive Mansfield Nottinghamshire NG19 6SQ 01623427846 01623429874 lantraz@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lantraz Co. Limited care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is : 45 The registered provider may provide the following categories 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 fall within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE. Date of last inspection Brief description of the care home Westfield Care Home is a modern, purpose built home providing care for up to 45 older people. The home is registered to provide care for people with dementia. The home provides long term, short term and respite care. The home has 3 lounges on the ground floor and three on the first floor, including a lounge for those people who wish to smoke. The bedrooms are on both floors, with a lift to the first floor. 11 of the Care Homes for Older People Page 4 of 27 Over 65 0 45 45 0 Brief description of the care home bedrooms have en-suite facilities. There are accessible gardens and space for car parking. The fees on the day of the inspection were £392 per week. 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: 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 focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last time we visited this service was 30th May 2008. We, as it appears throughout the Inspection Report refers to The Care Quality Commission. Two inspectors carried out an unannounced site visit to the agency, which took place over five and a half hours. The Registered Manager and the care co-ordinator assisted us during the site visit to the home. The staff also assisted us and were very helpful Care Homes for Older People Page 6 of 27 and friendly. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service, this is called an AQAA (Annual quality assurance assessment). We received the AQAA back from the manager in good time. The form was completed well and gave us all the information we asked for. We also sent out surveys called, have your say, to people who use the service, staff that work there and relatives. This meant we could get an idea of what people thought about the way the home was run. We had 16 completed surveys back and we have included some of the comments in this report. We have not included comments that could identify the writer as we want people to feel they can be open about the way they feel the service is run. We also reviewed all of the information we have received about the agency since we last made a visit to them and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking, which involved us choosing two people who use the service and one person who used to use the service. We looked at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with the manager, three members of staff and several people who use the service to help us to form an opinion about the quality of the service being provided to people. We read documents as part of this visit and looked at the environment and facilities of the home to form an opinion about the health and safety of people who use at the service. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body 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. 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 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 9 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. People that are admitted to the home have their needs assessed prior to admission, which means staff will be able to plan for their individual needs and know how to care for them. Evidence: The manager told us in the Annual Quality Assurance Assessment that each bedroom has a service user guide displayed and that people are given adequate information about the home so that they can make an informed choice. They also told us that each person has a full assessment before admission and that information is also gained from family and friends. We viewed the care plans of two people who had been admitted to the home and they both contained a full needs assessment. There was also a copy of a letter that the manager had sent to the person confirming that the home could meet their needs. Care Homes for Older People Page 10 of 27 Evidence: We spoke with one person who lives in the home and they told us that their family had visited the home and received information. This person then stayed in the home for a week before deciding to live there. We spoke with two visitors to the home and they told us that the home had completed an assessment on their relative before they had been admitted and that they had been able to visit the home before deciding if it was the right place. The home does not offer intermediate care and so standard six does not apply. Care Homes for Older People Page 11 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 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 up to date and relevant care plans, which give guidance to staff to deliver the appropriate individual care. Some of the homes medications procedures are not safe. Evidence: The manager told us in the Annual Quality Assurance Assessment that care plans were always formulated with the assistance of the service user and their relative and that they are reviewed at least monthly. They also said that service users have access to a GP, chiropodist, dentist and optician and that only staff that are trained to administer medication can do so. They told us that staff are trained on induction in respecting peoples privacy and dignity. We viewed the care plans of two people living in the home and one person who used to live in the home. The care plans were well documented and well organised with clear action to inform staff how they should deliver care to the individual. There was evidence of external health professionals being contacted when needed. There was also evidence that the home manages the pressure sores well through clear care Care Homes for Older People Page 12 of 27 Evidence: planning. Staff told us in surveys that they received training which gave them enough information about health care and medication. We received surveys from people living in the home and they told us that they received medical care when they needed it. They also said that they received the care and support that they needed. One relative told us. My relative is healthier now than when they moved in. We looked at the medication systems in the home. We found that the systems were organised but we also found some gaps in the systems. One person had not received their medication for one dose and we were told that was because the pharmacist had not delivered the medication for that person on time. There were a few gaps in signatures on the medication administration chart (MAR) and bottled medicines were not being dated when they were opened. We spoke with staff about how they ensured people living in the home had their privacy and dignity respected and they gave good accounts of how they managed this. We also observed how the staff interacted with people living in the home and we found the interaction to be warm and positive. However we received information that there are sometimes problems with laundry items going missing and there had been an occasion when a person living in the home was wearing someone Elses clothing. We viewed the laundry area and it was well organised with the required equipment in place. We saw evidence of some items of laundry being labeled with peoples room numbers rather than their name. This could cause confusion if someone changed rooms or were discharged from the home. Care Homes for Older People Page 13 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. People that live in the home are given the opportunity to participate in recreational activities and maintain social contacts. People receive a nutritious and appetising diet. Evidence: The manager told us in the Annual Quality Assurance Assessment that with the assistance of an activities organiser people have a varied activities programme. People are taken to pubs, church services, shopping trips and out for meals. They also told us that service users are supported to exercises their choices with regard to choosing what time to get up and go to bed and what to eat from the menu. We viewed three care plans and saw evidence of people being involved in activities in the home and on trips outside the home. On the day of the inspection staff went round and asked people if they wished to play bingo and they supported people during this activity. We spoke with a person living in the home and they said that there were activities in the home and staff that we spoke to said that the activities organiser worked every day during the week and did individual activities with people such as baking, games, trips to the local pub and shopping in town. Care Homes for Older People Page 14 of 27 Evidence: We received surveys back from people living in the home and they told us that there was always or usually activities that they could take part in. A member of staff told us in a survey, The home offers activities on a daily basis to stimulate and entertain the residents. One person living in the home told us, I have lots of support and friends here. We spoke to a person living in the home and they told us that it was their choice what time they went to bed at night and got up in the morning and staff respected this. Some people could not remember due to dementia but records in care plans and discussions with staff showed that people are given choices about these areas of daily living. We saw visitors in the home and they told us that they were able to visit anytime they wished. Surveys completed by relatives told us that the home helped their relative to keep in contact with them. One relative said, The home keeps me informed at all times if my relative has any problems. We observed lunch and saw people being given a choice of meal and the food looked appetising and nutritious. We saw staff having time to give support to people that needed help with their meal. Peoples independence was encouraged by staff in the way they assisted them and with the availability of specialist items such as plate guards. Lunch was a pleasant and relaxed experience. People living in the home told us in the completed surveys that they enjoyed the meals in the home. Care Homes for Older People Page 15 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. People living in the home know how to make a complaint and staff know how to safeguard them from abuse. Senior staff do not know how to refer allegations of abuse to the appropriate external agencies. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that there is a complaints procedure on display, a suggestions box in the conservatory and that complaints are dealt with. They also stated that all staff are given training on safeguarding and whistle blowing on a regular basis. During the last twelve months the home has received 5 complaints and the Commission have received three complaints about the service. On the day of the inspection the complaints procedure was up to date and on display in the reception area. We spoke with the care co-ordinator and they told us that it was part of their role in the home to encourage relatives and people who live in the home to raise concerns if they had any. We received surveys back from staff and they all said they knew what to do if someone raised a concern with them. We received surveys back from people living in the home and they told us that they Care Homes for Older People Page 16 of 27 Evidence: knew who to speak to if they were not happy. Relatives told us that if they had raised concerns the manager had always dealt with them appropriately. One relative told us, The home makes me feel part of the family and if I have any worries I can speak to someone. We viewed the complaints records in the home and these provided evidence that the home takes complaints seriously and acts on them within the specified timescale. We case tracked one person whos relative had made a complaint to the home and to the Commission and the complaint had been well documented and addressed appropriately. Action had been taken as a result of the complaint to ensure the risk of it happening again was minimised. The home has up to date local safeguarding procedures in place. We viewed the files of five members of staff and all contained evidence that these members of staff had received training in safeguarding people from abuse. We spoke with two members of staff and they gave a good account of safeguarding procedures in the home. However, the senior staff in the home have not been trained in how and when to refer allegations of abuse to the appropriate external agencies. Care Homes for Older People Page 17 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. People live in a safe, comfortable and homely environment and people are protected from the risk of the spread of infection. Evidence: The manager told us in the Annual Quality Assurance Assessment that the bedrooms are decorated and maintained to the highest standards and that the grounds are well maintained and equipment regularly serviced. They also state that there is an infection control policy in place and staff are aware and made to strictly adhere to it. On the day of the inspection, the areas of the home that we viewed were clean and well maintained. We found the home to be warm, welcoming and well organised, with a homely atmosphere. Communal areas were well presented and arranged to give a choice of seating and all areas seen were well maintained. Bedrooms were clean, personalised and tailored to meet individual needs and wishes. One person living in the home told us that when they moved into the home they had a different bedroom but they had not liked it. They had spoken with the manager and she had let them choose another bedroom and they had settled well. The garden was very attractive and was set out in a way that people could enjoy different areas. The garden is not secure enough for people with dementia to enjoy it Care Homes for Older People Page 18 of 27 Evidence: without supervision. However the manager told us that the activities organiser and the staff often take people out into the garden. Bedrooms contained specialist equipment where needed. This means people that live in the home have the right equipment to support their health care needs. Staff are trained in infection control procedures and we observed staff using appropriate protective clothing and following the correct procedures. Care Homes for Older People Page 19 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. The home operates a safe staff recruitment process and staff are trained effectively in supporting people living there. Evidence: The manager told us in the Annual Quality Assurance Assessment that the homes recruitment policy is robust and that new starters are given induction to the common induction standards and that staff training is a priority. We viewed several staff files and they all contained evidence that the required checks had been carried out on staff before they commenced working at the home. Some of the staff files did not contain an up to date photograph of the staff member or the date in which they started working in the home. However, the manager was able to provide us with their starting dates from her files and some of the files contained a copy of the persons passport. We spoke with staff working in the home and looked at their training certificates and this gave us evidence that the manager recognises the importance of a well trained workforce. The manager has recently implemented a recognised common induction for staff and we saw evidence of this on the day of the inspection. Care Homes for Older People Page 20 of 27 Evidence: We received surveys back from staff and they told us that they felt the induction they had received covered everything they needed to know about the job when they started working at the home. They also told us that they felt they had enough support, experience and knowledge to do the job. One visitor told us in a survey that they felt that the home was sometimes a little short staffed. However, on the day of the inspection there were enough staff on duty to meet the needs of the people living in the home and staff we spoke with told us that there was usually enough staff on duty. We found the staff to be very friendly and helpful and the people living in the home that we spoke to said that the staff were very good and always listened to what they had to say. One person said, We are like one big family. We received a survey back from a visitor and they told us that the home makes them feel part of a family. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people living there and people using the service are given the opportunity to express their views and give their opinion of how the home is run. Evidence: The manager sent the Annual Quality Assurance Assessment back to us by the specified date and it contained all the information we needed to plan the inspection. In it the manager told us that she holds the required qualifications and attends periodic training to keep up to date with current issues. She told us that questionnaires are circulated to service users and their families to obtain their views about the management of the home. We viewed the surveys that the home had circulated to people living in the home and their relatives. The surveys had then been analysed and the results were on display on the day of the inspection. Clear action had been identified for the manager to address as a result of the surveys. Care Homes for Older People Page 22 of 27 Evidence: People living in the home have regular meetings where they discuss issues about the home such as meals and activities. The minutes of the meetings clearly showed what action the manager had taken as a result of the meetings. We viewed the minutes of the staff meetings which are held regularly in the home and we saw evidence of the manager addressing areas of improvement that was needed and what action staff should take. Staff told us in completed surveys that the manager met with them regularly to give them support and discuss the way they were working. We spoke with people living in the home, their relatives and staff and they all told us that the manager was approachable and acted on what they said. One member of staff told us in a survey, My opinion of this home is very high. It has a friendly atmosphere, the care and the manager are excellent and the cleanliness is the best I have seen in a home. We viewed the personal spending money kept by the home for the people we had case tracked and we found that they were being managed appropriately. We viewed some health and safety management documentation and found evidence that these were being maintained and that staff were trained in all areas of health and safety. Accident records in the home were well documented and there was a clear audit trail from the accident records to peoples care plans. Care Homes for Older People Page 23 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 24 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 1 8 13 The home should address the issue with the pharmacy regarding medication not always being delivered on time for staff to administer prescribed medicines. This will ensure people take their medication as prescribed. 22/06/2009 2 18 13 The homes internal safeguarding policy should include information on how to make a referral to the safeguarding team and be available for senior staff to use. This will ensure senior staff have the correct information on how to make a safeguarding referral if needed. 24/07/2009 3 18 13 The manager and the more senior staff in the home must receive training in when and how to make 20/11/2009 Care Homes for Older People Page 25 of 27 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 safeguarding referrals to the external safeguarding team. This will ensure people living in the home are safe. 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 2 3 4 5 9 9 10 10 10 A monthly audit should be introduced so that gaps in signatures on the MAR can be identified and acted on. Medicines in bottles and boxes should be dated on opening. Staff should label peoples laundry with their name or initials and not with a room number. Staff should take care when assisting people with dressing that the clothes belong to that person. Identify a way to audit the lost laundry items, such as a lost property book, so that a record can be kept of missing items to help staff to identify items that are found in the future. When people take part in daily activities such as household chores, staff could record this in the same way they record activities such as bingo. Consider making some of the garden secure so that people with dementia can go into the garden without having to be escorted by staff. Ensure the start date is completed in staff files. Each staff file should contain an up to date photograph of the member of staff. 6 12 7 19 8 9 29 29 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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