Care Home: Westfield House

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What the care home does well Westfield House offers a good standard of care and comfort to all its residents. There has been a change of provider and manager since the last inspection. The home is now owned by the company Black Swan who manage several other care homes in the county. The manager is actively supported on a daily basis by one of the companies operational directors and receives support from other Black Swan care home managers. It is customary for a senior care staff to take charge of the shift, working alongside a junior carer. There are dedicated domestic staff and an activities coordinator, this ensures that care staff can concentrate their efforts on meeting residents needs. All those members of staff spoken with and observed were found to be pleasant and appeared thoughtful, respectful and caring towards residents. All residents needs are assessed prior to admission and the written information about the home is clear and informative. Care plans are subsequently devised then regularly reviewed by senior staff. Residents relatives or representatives are, whenever possible, closely involved in this process. The care home offers regular sessions of activities or pastimes for residents and there are periodic outings. As on the previous inspection, the food was highly praised by residents and by their relatives. The staff have commenced an organised weekly cream tea on a Friday afternoon for the residents and some relatives take the opportunity to visit and take tea with their relatives. One relative said she welcomed the opportunity to comment on the care home, praising its management and staff and stated she found it impossible to fault the service and was very happy with the care her relative received. What has improved since the last inspection? The previous inspection resulted with one requirement and that was to employ a registered manager. This has now been completed. The care home has changed providers and is now owned and managed by the company Black Swan. The care plans have been changed, the staff now use the companies records which include additional details on the activities of daily living. Although, because of the short time frame in adapting these records the staff need to develop the past life history of their residents to ensure that activities and pastimes are suited to individuals. Since Black Swan took over Westfield House their have been five of the fourteen bedrooms been completely refurbished, the ground floor bathroom was currently being redecorated with a newly adapted bath. Several communal areas have also been repainted and some chairs have been replaced. There is also an activities coordinator who has taken over the role in organising and providing activities, parties, outings and special events for the residents. During the inspection several residents were occupied with personal interests and hobbies such as knitting, reading and taking part in arts and crafts. The manager has been working closely with residents GP`s over the past few months to review and reduce medication for people who have anxiety and confusion due to there dementia and this has proved successful in the majority of cases. What the care home could do better: Three recommendations and one requirement were discussed with the manager to enable her to develop the care better for the residents. The life history of residents could be broadened to enable the care staff to initiate conversation about their past life and adapt activities to suit each individuals need. The medication records for variable medicines contained gaps and this needs to be reduced. Staffing levels are at minimum levels of care staff, so the manager must recognise when dependency levels alter for residents then staff numbers need to be increased. The top windows on the first floor open quite wide and this should be assessed for risk to residents. Key inspection report Care homes for older people Name: Address: Westfield House 12 Westfield Road Dereham Norfolk NR19 1JB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Hilda Stephenson     Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC 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: Westfield House 12 Westfield Road Dereham Norfolk NR19 1JB 01362697828 01362851704 headoffice@blackswan.co.uk www.blackswan.co.uk Black Swan International Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 16 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 people who can be accommodated is 16 The registered person may provide the following category of service only, Care Home only, Code PC, to people of the following gender, either, whose primary care needs on admission to the home are within the following categories, Old Age, not falling within any other category, Code OP, Dementia, Code DE Date of last inspection Brief description of the care home Westfield House is a town house adapted to care for up to sixteen people with care needs of dementia. There are fourteen single and two shared bedrooms with access to a bathroom on both the first and ground floor. The home has recently changed providers and is now owned by the company Black Care Homes for Older People Page 4 of 26 Over 65 0 16 16 0 Brief description of the care home Swan who own and manage several other care homes. The communal rooms consist of two lounges and a large conservatory with access to the large enclosed rear garden. The home has its own minibus and car. There is a new manager in post who has worked for the company for several years. The home can accommodate residents from both the private and local authority sector. Fees range from £351-£460 per week with additional charges for hairdressing, chiropody, personal toiletries and newspapers. 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 focus of the inspection undertaken by the Care Quality Commission is upon outcomes for people who use the service and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. One inspector conducted the unannounced visit. The main method of inspection used is called case tracking which involves selecting people who use the service and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. The manager, operations manager and two members of staff were spoken with as part of the visit, records relating to medication management was also inspected to form an Care Homes for Older People Page 6 of 26 opinion about the quality of care provided. A partial tour of the building was undertaken which included peoples bedrooms and communal areas they frequent to make sure that the environment is homely and safe. A review of all the information we have received about the home since the last key inspection was considered in planning this visit which included the Annual Quality Assurance Assessment which was provided by the manager. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? The previous inspection resulted with one requirement and that was to employ a registered manager. This has now been completed. The care home has changed providers and is now owned and managed by the company Black Swan. The care plans have been changed, the staff now use the companies records which include additional details on the activities of daily living. Although, because of the short time frame in adapting these records the staff need to develop the past life history of their residents to ensure that activities and pastimes are suited to individuals. Since Black Swan took over Westfield House their have been five of the fourteen bedrooms been completely refurbished, the ground floor bathroom was currently being redecorated with a newly adapted bath. Several communal areas have also been repainted and some chairs have been replaced. There is also an activities coordinator who has taken over the role in organising and providing activities, parties, outings and special events for the residents. During the inspection several residents were occupied with personal interests and hobbies such as knitting, reading and taking part in arts and crafts. The manager has been working closely with residents GPs over the past few months to Care Homes for Older People Page 8 of 26 review and reduce medication for people who have anxiety and confusion due to there dementia and this has proved successful in the majority of cases. 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 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 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 10 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be assessed and have the written information about the service before moving in Evidence: The manager visits all prospective residents who enquire about the service and facilities at their place of admission, and obtains professional assessments to be considered for admission. The manager said that after the initial contact she would visit the person considering moving to Westfield House to assess their individual care, mental health and social needs to ensure that the staff can care for them appropriately. The admission details were read of the last resident who was admitted. These contained details of the personal care needs and no specialist equipment was required before they moved in. There was evidence of the written information that was given to Care Homes for Older People Page 11 of 26 Evidence: the new person to read in the form of the statement of purpose, service user guide and the homes own brochure containing pictures of the facilities. The resident confirmed as best as they could that they had been happy with the support they had received since moving in. The manager said that every new person is invited to visit the home beforehand, to see their room, have a meal with other residents or even stay overnight, whichever is appropriate for them, without adding to any confusion. The manager obtains information from the family, advocate or social worker during the admission process so they are able to support the new resident through this unsettling process. A sample of the contracts drawn up stating fees to be paid, extra charges, room to be occupied and how to leave the home was seen, these were signed by the resident or a family member or advocate. Staff explained how they support new residents by helping them settle into their new environment, by being available in case they become unsettled or distressed. The home does not take residents for intermediate care but does offer respite care if a room is available. Care Homes for Older People Page 12 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 will receive support with their health and social needs. Evidence: Two care plans of residents chosen at random were read. They followed the activities of daily living needs and were based on their assessed needs which was individually driven. Each care plan focused on the individual needs, records of professional visits and risk assessments in place for each person to live as independently as possible. With daily records in place this gave a view of the persons life within the home. The past history of each resident was rather brief and staff should consider how they can obtain more details about the residents past family and work life as well as their past interests. This would enable staff to broaden conversation and activities to suit individuals. The lunch time administration of medication was observed and appeared to be a safe system. The senior carer explained the process of ordering and returning medication and the medication charts were checked. There were some gaps seen on these charts Care Homes for Older People Page 13 of 26 Evidence: and this came across as rather confusing for some PRN (Per Required Need) medication. This was discussed with the manager who will need to put in place a safer recording method to ensure staff record whether the medication was given or offered, of the variable doses. The home has an adequate procedure for the dispensing of controlled drugs and a register for staff to witness and sign. The manager explained since she had been in post she has assisted GPs to reduce some medication for residents to help eliminate confusion and anxiety which comes with dementia and had been successful in some cases showing that residents care and health needs are constantly reviewed demonstrating good practice. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be supported to live their lifestyle and have choices in their day to day life. Evidence: The home employs an activities coordinator who works five days a week specifically to spend sociable time with residents. She does no care work, although helps with meals if required. A weekly list of activities was displayed and records of residents taking part in activities was recorded. Activities offered are:- musical bingo, shopping trips, reminiscence, memory boxes, jigsaws, games, arts and crafts. An outing to Wells for fish and chips was planned for January. The home has access to a minibus and car. During this visit people were being occupied with jigsaws, painting and colouring pictures. One was knitting, another was reading a paper. Some were watching TV in one lounge, and others were asleep in the quiet lounge. Two residents had visitors. These were spoken to. I come in once a week and give mum some snacks, the staff here are very helpful and friendly, I always get offered a cup of tea. Care Homes for Older People Page 15 of 26 Evidence: If a resident becomes distressed or anxious, the staff try to ease their discomfort, they have lots of patience. One resident was walking round the home trying to dust and moving books around. The care plans recorded some interests but this needs to be broadened, as stated in the previous standard. The kitchen was clean and tidy. The cook discussed the menu which is over a four weekly rota. Todays lunch consisted of ham, egg, mash and fresh vegetables and jam sponge and custard. There is only one main meal offered, although the cook demonstrated that she asks residents what they would like as an alternative, if they dont wish for the main meal. Tea time was a variety of sandwiches or spaghetti on toast, with a yoghurt or fruit for afterwards. Supper consisted of biscuits and a milky drink. Breakfast was cereal, porridge toast, and sometimes a cooked breakfast, making a change to the routine. The cook makes homebakes for tea and snacks for 3pm and every Friday the staff and residents have tea and fresh cream scones for tea where the tables are laid for this and some relatives join in. The residents were seen using a mix of individual tables and dining tables for their lunch. Some staff were assisting residents, although most residents just needed a prompt. The lunch was served from a hot trolley by the cook. Tea time the care staff serve the meal, an third carer comes in to help with this meal. There was a visitors book at the front door, showing numbers visiting each day. Records showed that residents are taken out into the community although, some residents did not take part in group activities. Care Homes for Older People Page 16 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 will be listened to and protected from harm. Evidence: The manager has a clear monitoring system in place to deal with and investigate any complaints. The written information sent prior to the inspection indicated that there had been no major complaints. The manager explained that if any complaints are brought to her attention then she follows a specific system to deal with them in an efficient and effective manner. Any complaints are also passed onto the senior management team within the company, to eliminate any repeat. The complaints policy displayed on the noticeboard states that any complaints are taken seriously to stamp out bad practice and are non judgemental with the investigations. There were no complaints highlighted when speaking to residents, relatives or staff during the inspection. All staff receive adult protection training during their induction programme, NVQ and attend regular adult protection training updates. Staff confirmed they understood the policy and how to protect the people they were looking after. The AQAA stated that new staff commence work after there crb checks and two written references were obtained. This was evident when checking staff files. 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. People live in a safe, warm and homely environment. Evidence: Westfield House caters for a small number of residents who have a dementia within the town of Dereham. It is a town house that has been converted to accommodate up to sixteen people. There are fourteen single bedrooms and two shared bedrooms, some having ensuite facilities. The bedrooms are situated on two floors and there is a bathroom on each floor too. The communal rooms are situated on the ground floor consisting of a large conservatory, one large lounge with three dining tables and a walk through smaller lounge containing one dining table. Both lounges have a television, a variety of chairs and sofas, with a music centre and reading material. The smaller lounge is also used to cater for arts and crafts. Residents have access to the rear garden. The manager said that the garden was planned for an upgrade to make it safer for frailer residents, and to have a sensory garden area. During the past few months the home was being upgraded, five bedrooms had been completely refurbished and one bedroom was currently being repainted while the residents was away. Care Homes for Older People Page 18 of 26 Evidence: Several bedrooms were seen during this visit and found to contain residents personal possessions making them more personalised. There was signs on bedrooms doors to assist residents to identify their own rooms. Some of the carpets in the communal rooms had been replaced. A new sign for the outside of the home had been erected. Facilities for residents laundry was situated at the rear of the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by sufficient numbers of well trained staff. Evidence: The manager said that the staffing levels are determined by the needs of the existing resident group. The day of inspection the rota showed that there were two care staff and the manager, the cook and the domestic staff were on duty to cater for the residents needs. During the week the rota showed that two care staff and the activities coordinator cared for residents. Continuing this level of support during the evening shift, with one of the three care staff serving tea and two care staff overnight. The manager said that when residents have appointments or outings are arranged then extra staff are brought in to cover. Two staff files were checked and these provided evidence that the manager does not commence new staff until they have been checked according to the recruitment policy. Then they are supported by the senior staff until they are competent to work on there own. All new staff follow the homes induction programme. Staff confirmed that they attend regular training courses relevant to the residents care Care Homes for Older People Page 20 of 26 Evidence: needs including moving and handling, infection control, food hygiene, dementia awareness, medication and fire training. The majority of the staff have already achieved the recommended level 2 NVQ training and they should be commended for this, with the senior staff reaching level 3. 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. People are offered a safe well managed home to live in. Evidence: There has been a change of manager since the previous inspection. Vicky Ward has been in post since May 2009. She has worked for the company Black Swan for several years and was previously a deputy manager in one of their sister homes until moving to Westfield House. She has enrolled to undertake the managers qualification commencing January 2010. She is currently receiving support and supervision from the company operational director who visits the home several days a week. Since the manager has been at the home there has been a quality assurance survey undertaken with any changes from this published and explained to residents and their relatives, such as the redevelopment of the garden. A further survey to monitor quality was currently taking place. Some residents personal spending money was kept safe with the manager and a Care Homes for Older People Page 22 of 26 Evidence: random selection of these were checked and found to be accurate. Staff receive regular supervision with the manager, these sessions are used to plan future training needs of each member and how there individual skills can be adapted within the home. A random selection of health and safety records were checked including fire, water temperatures, window restrictors, moving and handling, COSHH, boiler and shaft lift records which were all satisfactory. Although, the top windows can open quite wide on the first floor and the manager needs to look at these to assess whether they can be a risk to residents safety. The building is made secure and visitors are requested to sign in when visiting the home so the staff know how many people are in the building, which is good practice. The insurance is up to date and registration certificate is displayed. 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 1 9 13 Variable medication records should contain no gaps. Records should show whether the resident has been issued or refused variable medication. 22/01/2010 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 The past history of residents should be obtained in more detail to assist staff to gain a better understanding of the resident as a whole person. The manager must constantly review staff numbers to keep in line with residents dependency levels. The top windows on the first floor open quite wide and should be assessed for risk to residents. 2 3 27 38 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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