CQC Inspection Report

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Inspection Report | The New City Medical Group | December 2013 www.cqc.org.uk 1

Inspection Report

We are the regulator:

Our job is to check whether hospitals, care homes and care

services are meeting essential standards.

The New City Medical Group

The New City Medical Centre, Tatham Street,

Sunderland, SR1 2QB

Tel: 01915675571

Date of Inspection: 14 November 2013 Date of Publication:

December 2013

We inspected the following standards as part of a routine inspection. This is what we

found:

Respecting and involving people who use

services

Met this standard

Care and welfare of people who use services

Met this standard

Cleanliness and infection control

Met this standard

Supporting workers

Met this standard

Assessing and monitoring the quality of service

provision

Met this standard

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Details about this location

Registered Provider Dr Sarah Schofield

Registered Manager Dr. Sarah Schofield

Overview of the

service

New City Medical Croup is a General Medical Service

practice with two full time partners. Additional appointments

are provided the Nurse Practitioner and practice nurses. The

surgery is in a purpose built surgery with consulting rooms

on both the ground and first floor. There is a lift to give

access to all areas of the building. It has good access to

public transport and is within walking distance of the centre

of Sunderland.

Type of services Doctors consultation service

Doctors treatment service

Regulated activities Diagnostic and screening procedures

Family planning

Maternity and midwifery services

Surgical procedures

Treatment of disease, disorder or injury

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Contents

When you read this report, you may find it useful to read the sections towards the back

called ‘About CQC inspections’ and ‘How we define our judgements’.

Page

Summary of this inspection:

Why we carried out this inspection 4

How we carried out this inspection 4

What people told us and what we found 4

More information about the provider 5

Our judgements for each standard inspected:

Respecting and involving people who use services 6

Care and welfare of people who use services 8

Cleanliness and infection control 10

Supporting workers 12

Assessing and monitoring the quality of service provision 14

About CQC Inspections

16

How we define our judgements

17

Glossary of terms we use in this report

19

Contact us

21

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Summary of this inspection

Why we carried out this inspection

This was a routine inspection to check that essential standards of quality and safety

referred to on the front page were being met. We sometimes describe this as a scheduled

inspection.

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service,

carried out a visit on 14 November 2013, observed how people were being cared for and

checked how people were cared for at each stage of their treatment and care. We talked

with people who use the service, talked with carers and / or family members, talked with

staff and reviewed information given to us by the provider. We reviewed information sent

to us by commissioners of services, reviewed information sent to us by other authorities,

talked with commissioners of services and talked with other authorities.

What people told us and what we found

We spent time during our visit observing how the practice worked and speaking to

patients, staff and stakeholders. Patients told us they felt their needs were met by the

practice and we saw positive exchanges between patients and staff. One person said,

“They always give me a good service,” Another said “Staff are really nice, including the

receptionists”.

Patients we spoke with told us they could always get an appointment when they needed

one and emergency slots were available if they needed to see a GP or nurse urgently.

One told us the doctors were “Excellent, they always explain what is wrong and what

treatment is available.”

Care and treatment was planned and delivered in a way that was intended to ensure

people’s safety and welfare. We saw the general practitioners followed national guidance

as well as local Clinical Commissioning Group (CCG) guidelines to make sure they were

following best practice.

We saw the practice was up to date with infection control policies and procedures and

when we spoke with staff they had a clear understanding how to reduce the risk of cross

infection. The surgery was clean and well maintained.

Staff were provided with support, guidance and training to make sure they were able to

carry out their role safely and their performance was monitored to maintain the standards.

The provider had an effective system in place to identify, assess and manage risks to the

health, safety and welfare of people who use the service and others.

You can see our judgements on the front page of this report.

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More information about the provider

Please see our website www.cqc.org.uk for more information, including our most recent

judgements against the essential standards. You can contact us using the telephone

number on the back of the report if you have additional questions.

There is a glossary at the back of this report which has definitions for words and phrases

we use in the report.

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Our judgements for each standard inspected

Respecting and involving people who use services

Met this standard

People should be treated with respect, involved in discussions about their care

and treatment and able to influence how the service is run

Our judgement

The provider was meeting this standard.

People’s views and experiences were taken into account in the way the service was

provided and delivered in relation to their care.

Reasons for our judgement

The practice manager confirmed that the information about the practice was on the NHS

choices website which also included a variety of patient information such as appointment

times and the specialist clinics and support available.

People were given information both about the practice and general health issues. We saw

a range of general health information and practice publicity in the waiting room on the

ground floor and in the small waiting room on the first floor. The small area on the first floor

close to the consulting rooms had a large range of targeted practice leaflets and

information which were season and theme specific, for example advice regarding flu

vaccines.

The practice staff were aware of the availability and access to the interpreting service,

should this be needed, and information was available to tell staff how to access it. The

practice manager was aware of the constraints for privacy in the waiting room and so they

had made available a booth type reception desk next to the main desk. She also gave

examples of private spaces which would be used where patients wanted to discuss

matters in private.

The surgery had a chaperone policy by which the practice nurse would act as chaperone,

however if not available the reception staff would provide the role. The availability of a

chaperone was made known to the patients through the practice leaflet and a notice in the

waiting area.

We saw that bookable appointments for all clinicians were generally available within 24

hours which suggested people could access the service. Patients told us they had not

experienced any problems getting appointments when they needed one. Urgent

appointments were also made available as necessary. Appointments were made available

at different times of day and the practice operated evening surgeries until 6pm Monday to

Friday.

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The practice used “Choose and Book”. The information we looked at confirmed that

patients were routinely given the choice of hospitals, although we were told most would

choose the local hospitals or take their advice regarding regional services.

The practice manager showed us leaflets, publicity and letters which the practice used as

part of the ‘Choose Well’ scheme to raise awareness of different NHS services and to

encourage patients to make the most appropriate use of these.

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Care and welfare of people who use services

Met this standard

People should get safe and appropriate care that meets their needs and supports

their rights

Our judgement

The provider was meeting this standard.

Care and treatment was planned and delivered in a way that was intended to ensure

people’s safety and welfare.

Reasons for our judgement

Care and treatment was planned and delivered in a way that was intended to ensure

people’s safety and welfare. We saw that the general practitioner followed national

guidance as well as local Clinical Commissioning Group guidelines for areas of care such

as hernia, urinary incontinence and rectal issues to ensure appropriate referrals. The

surgery used the national systems for patient information leaflets.

We spoke with six patients and without exception, they told us they were satisfied with the

standard of care they received at the practice. One person said, “I have always seen Dr

Partington, but the one I have seen recently is really good as well” and another said “I had

to be referred to the hospital and they sorted it out for me, I was really happy, all staff are

really good”.

Patients we spoke with said their appointments were sometimes delayed but never for

very long and that they were kept informed of any delay. They told us they were given the

time they needed with the doctor to discuss their health issues or concerns. We observed

people using the touch screen technology to register their arrival in the practice; the usual

reception desk checking in system was also available.

The practice had equipment for managing emergencies with medication and other

resuscitation equipment. All items including drugs were within the expiry date and regular

equipment checks were undertaken. We saw all the staff had access to the information

they needed about clinical protocols on line.

The computer system included an alert which appeared on the screen when a patient is

seen, for example people on special medication or one who is overdue for a monitoring

visit for a chronic condition. Also children who are on an “at risk register” are identified in

the “problem page” of the patient computerised record.

We looked at how the surgery managed certain conditions, including asthma, and

diabetes. We saw clear treatment plans were in place for people, dependent on the

medical condition and these were managed by the particular member of staff identified.

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The administration staff had specific roles in the management of chronic disease

management and this was overseen by the practice manager.

The practice had recently achieved the Palliative Care award and had reviewed the way

they met the needs of people requiring this service including their medication and clinical

information about their care. We were told about specific meetings held with members of

the primary health care team these included palliative care meetings and meetings

regarding children at risk.

Health promotion information, such as diet and exercise advice was available in the

waiting room on the electronic display board; there was also a large selection of pamphlets

and leaflets in the waiting room. One patient told us, “They make sure we have the right

information for us to choose a healthy lifestyle”.

The doctor and nursing staff continued to maintain their skills and competencies as part of

their on-going professional registration. This is checked by the practice manager to ensure

that the registration remains current.

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Cleanliness and infection control

Met this standard

People should be cared for in a clean environment and protected from the risk of

infection

Our judgement

The provider was meeting this standard.

People were protected from the risk of infection because appropriate guidance had been

followed and people were cared for in a clean, hygienic environment.

Reasons for our judgement

We spent time with the staff on duty during the visit and asked them about their

understanding of how they assessed the risk, detected, prevented and controlled the

spread of health care associated infections.

We spoke with the Nurse Practitioner who took responsibility for infection control. She told

us that disposable equipment was used for specific clinical procedures such as cervical

smears. We saw how this equipment was stored and managed, for example aprons and

disposable gloves available in all of the clinical areas. She told us disposable items were

used and disposed of in line with best practice guidelines. There was a system for labelling

and disposing of clinical waste which was carried out by the contractor responsible for

removal of the waste.

We saw there were separate hand wash sinks available for people to clean their hands.

Not all of the hand washing areas had advice displayed to give people appropriate

guidance on good hand wash technique. We were told by the practice manager that this

had been addressed following our visit. Hand wash gel was available from dispensers in

the entrance to the clinical areas. This meant that patients and staff were being support to

maintain good hand hygiene practices.

The clinical areas were clean, tidy and well organised. We saw effective systems in place

to ensure that unused (clean) and used (dirty) equipment were stored appropriately. We

reviewed files which contained guidance to support staff to ensure they were following

good practice guidelines, for example personal protective equipment such as gloves.

We saw that the practice had a domestic cleaner employed directly by the practice. This

meant they could monitor the standards and make any amendments to the cleaning

schedule if necessary. The practice was clean and well maintained.

We spoke with several patients during or after the inspection and they told us they were

happy with the standard of cleanliness. Comments included: “The surgery is clean and

well organised” and “I’ve never given it a thought which probably means it’s always clean.”

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Most of the furnishings and floor coverings in the surgery, including those fitted in the

consulting rooms were washable. We noted the use of some pillows used on the

examination couches needed new covers to make them water proof. Plans were in place

to address these issues.

A policy, with the relevant contact details was available to enable the staff to respond

appropriately in the event of an outbreak of a communicable disease. An infection control

policy was also in place which was reviewed annually.

There were effective systems in place to reduce the risk and spread of infection.

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Supporting workers

Met this standard

Staff should be properly trained and supervised, and have the chance to develop

and improve their skills

Our judgement

The provider was meeting this standard.

People were cared for by staff who were supported to deliver care and treatment safely

and to an appropriate standard.

Reasons for our judgement

The practice manager was responsible for ensuring all staff were up to date with the

training they needed to carry out their role. She did not have an overview of all of the

mandatory training staff required to carry out their role. The provider may find it useful to

note that introducing this would give her the opportunity to identify what staff training to

organise and which staff needed to be updated.

We spoke with the Nurse Practitioner who showed us the records of the training she had

completed. She had undertaken all of the training she required to carry out her role safely

and maintained her competence by undertaking updates of the training in line with relevant

guidance. For example she had recently attended updates on cervical screening and

holiday vaccinations. She had also identified, as part of her professional development, that

she would like to develop her knowledge in sexual heath so that she could provide a more

extensive service to the patients in the practice. This training had recently been arranged.

We reviewed the training with the practice manager and found that some additional

training, or updates of the training was required. A receptionist told us she had received

the training she needed to carry out her role, for example read code training and training

for the new IT system. She also told us she had received training in first aid and fire

prevention and evacuation. Another receptionist confirmed she had also had received the

mandatory training and we saw their certificates which they held in their own training

records.

We saw records which showed that staff had received training in safeguarding, health and

safety and resuscitation, however there were gaps in statutory staff training for fire training

and adult protection training. Also training in dealing with complaints would have been

helpful for staff. The practice manager confirmed following the visit that training had been

identified and arranged for those staff who needed updates. The provider may find it useful

to note that this training must be maintained to make sure staff were safe and to maintain

the safety of others.

We spoke with the doctor who told us they maintained their own training in line with the

registration requirements. We checked the registration status of the doctors working in the

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practice, they were appropriately licensed. This means that they were subject to

revalidation of their ability to practice which included maintaining their training and having

regular appraisals.

The staff we spoke with told us they had annual appraisals with the practice manager we

saw the records of these and they were up to date. The new practice manager had carried

out an appraisal with each of the staff in 2013. When we spoke with the staff they told us

these gave them an opportunity to their further training and development needs. Staff told

us they could speak with the practice manager and the doctors if they had any concerns or

they thought things could be done differently or better.

The staff we spoke to said they felt supported to carry out their role. For example, the

practice nurse told us she could attend practice nurse groups locally and received informal

clinical support from the doctor and practice nurses who were co-located in the health

centre. She also told us she could speak to other nurses in the health centre and that the

doctor was “Very approachable”.

We noted there were sufficient numbers of staff on the day, which was the normal staffing

complement, to provide effective levels of support and care to the patients using the

service which meant that the staff could carry out their role effectively.

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Assessing and monitoring the quality of service

provision

Met this standard

The service should have quality checking systems to manage risks and assure

the health, welfare and safety of people who receive care

Our judgement

The provider was meeting this standard.

The provider had an effective system to regularly assess and monitor the quality of service

that people receive.

Reasons for our judgement

We looked at the way the practice made sure patients received safe quality care,

treatment and support, due to effective decision making and the management of risk to

their health welfare and safety.

Records of significant events were kept in line with the practice policies and they contained

a date when they had been reviewed. All incidents were reported on the ‘Datax’ database.

For example there was an event in which the security of the medication cupboard had

been compromised. Action was taken immediately and a plan was put in place to prevent it

reoccurring.

During the visit we saw patient records stored in unlocked filing cabinets (and some on top

in open boxes) in a room which was not locked or secured. They could be accessed by

people using a meeting room and an adjoining room used by patients during surgery

times. The practice manager told us that these rooms were never accessed by people

unless accompanied by a member of staff but agreed that this could not be guaranteed as

they were on a shared corridor. We were given evidence following the visit that this had

been addressed by the addition of key pad locks to these rooms. This meant that patient

records could be kept safe and patient confidentiality could be ensured.

The surgery had a first aid book and risk and Incident forms, a copy of these would be sent

to clinical commissioning group as necessary and one copy kept on file at the practice.

The practice manager told us she reviewed the surgery risk assessments and was aware

of the elements required to ensure it was complete and up to date.

We looked at the quality and outcome framework (QOF) GP practice results. This showed

the practice was continuing to review its activity for chronic disease management, for

example, asthma, diabetes, hypertension, and mental health.

There was a practice complaints procedure which was implemented by the practice

manager. She told us she would handle any concerns, as was identified in the practice

leaflet.

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The practice manager described the practice system for dealing with mail and read coding,

which is detailed clinical coding of multiple patient information, such as social

circumstances, clinical signs, laboratory tests and results, diagnosis etc. This showed that

at each stage of the process there was an audit trail. The secretaries also had

responsibility of reviewing new patient records and adding relevant read codes.

The practice held formal internal meetings which meant that they kept staff up to date with

relevant information during these meetings and during informal discussions. There were

also weekly clinical meetings. This meant staff were receiving the information they

required to give them the opportunity to participate in the running of the practice and

discuss clinical issues.

The following audits had been carried out recently: waiting times for cancer patients,

erectile disfunction management and referrals and statin prescribing patterns.

The practice had a patient participation (PPI) group arranged and led by the practice

manager. We saw that recent changes had been made to the patient registration form

which included information about the PPI group and an invitation to take part. There was

also a practice newsletter which was available in the waiting rooms and was going to be

added to the website.

There was an identified safeguarding lead and all staff we spoke with were aware of this.

They confirmed they had received training at the relevant level for their role although

updates were needed.

There was an up to date fire plan and evacuation procedure and the practice had a

business continuity plan. The provider had an effective system in place to identify, assess

and manage risks to the health, safety and welfare of people using the service and others.

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About CQC inspections

We are the regulator of health and social care in England.

All providers of regulated health and social care services have a legal responsibility to

make sure they are meeting essential standards of quality and safety. These are the

standards everyone should be able to expect when they receive care.

The essential standards are described in the Health and Social Care Act 2008 (Regulated

Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations

2009. We regulate against these standards, which we sometimes describe as “government

standards”.

We carry out unannounced inspections of all care homes, acute hospitals and domiciliary

care services in England at least once a year to judge whether or not the essential

standards are being met. We carry out inspections of other services less often. All of our

inspections are unannounced unless there is a good reason to let the provider know we

are coming.

There are 16 essential standards that relate most directly to the quality and safety of care

and these are grouped into five key areas. When we inspect we could check all or part of

any of the 16 standards at any time depending on the individual circumstances of the

service. Because of this we often check different standards at different times.

When we inspect, we always visit and we do things like observe how people are cared for,

and we talk to people who use the service, to their carers and to staff. We also review

information we have gathered about the provider, check the service’s records and check

whether the right systems and processes are in place.

We focus on whether or not the provider is meeting the standards and we are guided by

whether people are experiencing the outcomes they should be able to expect when the

standards are being met. By outcomes we mean the impact care has on the health, safety

and welfare of people who use the service, and the experience they have whilst receiving

it.

Our inspectors judge if any action is required by the provider of the service to improve the

standard of care being provided. Where providers are non-compliant with the regulations,

we take enforcement action against them. If we require a service to take action, or if we

take enforcement action, we re-inspect it before its next routine inspection was due. This

could mean we re-inspect a service several times in one year. We also might decide to reinspect

a service if new concerns emerge about it before the next routine inspection.

In between inspections we continually monitor information we have about providers. The

information comes from the public, the provider, other organisations, and from care

workers.

You can tell us about your experience of this provider on our website.

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How we define our judgements

The following pages show our findings and regulatory judgement for each essential

standard or part of the standard that we inspected. Our judgements are based on the

ongoing review and analysis of the information gathered by CQC about this provider and

the evidence collected during this inspection.

We reach one of the following judgements for each essential standard inspected.

Met this standard

This means that the standard was being met in that the

provider was compliant with the regulation. If we find that

standards were met, we take no regulatory action but we

may make comments that may be useful to the provider and

to the public about minor improvements that could be made.

Action needed

This means that the standard was not being met in that the

provider was non-compliant with the regulation.

We may have set a compliance action requiring the provider

to produce a report setting out how and by when changes

will be made to make sure they comply with the standard.

We monitor the implementation of action plans in these

reports and, if necessary, take further action.

We may have identified a breach of a regulation which is

more serious, and we will make sure action is taken. We will

report on this when it is complete.

Enforcement

action taken

If the breach of the regulation was more serious, or there

have been several or continual breaches, we have a range of

actions we take using the criminal and/or civil procedures in

the Health and Social Care Act 2008 and relevant

regulations. These enforcement powers include issuing a

warning notice; restricting or suspending the services a

provider can offer, or the number of people it can care for;

issuing fines and formal cautions; in extreme cases,

cancelling a provider or managers registration or prosecuting

a manager or provider. These enforcement powers are set

out in law and mean that we can take swift, targeted action

where services are failing people.

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How we define our judgements (continued)

Where we find non-compliance with a regulation (or part of a regulation), we state which

part of the regulation has been breached. Only where there is non compliance with one or

more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a

judgement about the level of impact on people who use the service (and others, if

appropriate to the regulation). This could be a minor, moderate or major impact.

Minor impact –

people who use the service experienced poor care that had an impact on

their health, safety or welfare or there was a risk of this happening. The impact was not

significant and the matter could be managed or resolved quickly.

Moderate impact –

people who use the service experienced poor care that had a

significant effect on their health, safety or welfare or there was a risk of this happening.

The matter may need to be resolved quickly.

Major impact –

people who use the service experienced poor care that had a serious

current or long term impact on their health, safety and welfare, or there was a risk of this

happening. The matter needs to be resolved quickly

We decide the most appropriate action to take to ensure that the necessary changes are

made. We always follow up to check whether action has been taken to meet the

standards.

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Glossary of terms we use in this report

Essential standard

The essential standards of quality and safety are described in our

Guidance about

compliance: Essential standards of quality and safety

. They consist of a significant number

of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the

Care Quality Commission (Registration) Regulations 2009. These regulations describe the

essential standards of quality and safety that people who use health and adult social care

services have a right to expect. A full list of the standards can be found within the

Guidance about compliance

. The 16 essential standards are:

Respecting and involving people who use services – Outcome 1 (Regulation 17)

Consent to care and treatment – Outcome 2 (Regulation 18)

Care and welfare of people who use services – Outcome 4 (Regulation 9)

Meeting Nutritional Needs – Outcome 5 (Regulation 14)

Cooperating with other providers – Outcome 6 (Regulation 24)

Safeguarding people who use services from abuse – Outcome 7 (Regulation 11)

Cleanliness and infection control – Outcome 8 (Regulation 12)

Management of medicines – Outcome 9 (Regulation 13)

Safety and suitability of premises – Outcome 10 (Regulation 15)

Safety, availability and suitability of equipment – Outcome 11 (Regulation 16)

Requirements relating to workers – Outcome 12 (Regulation 21)

Staffing – Outcome 13 (Regulation 22)

Supporting Staff – Outcome 14 (Regulation 23)

Assessing and monitoring the quality of service provision – Outcome 16 (Regulation 10)

Complaints – Outcome 17 (Regulation 19)

Records – Outcome 21 (Regulation 20)

Regulated activity

These are prescribed activities related to care and treatment that require registration with

CQC. These are set out in legislation, and reflect the services provided.

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Glossary of terms we use in this report (continued)

(Registered) Provider

There are several legal terms relating to the providers of services. These include

registered person, service provider and registered manager. The term ‘provider’ means

anyone with a legal responsibility for ensuring that the requirements of the law are carried

out. On our website we often refer to providers as a ‘service’.

Regulations

We regulate against the Health and Social Care Act 2008 (Regulated Activities)

Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.

Responsive inspection

This is carried out at any time in relation to identified concerns.

Routine inspection

This is planned and could occur at any time. We sometimes describe this as a scheduled

inspection.

Themed inspection

This is targeted to look at specific standards, sectors or types of care.

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Contact us

Phone: 03000 616161

Email: enquiries@cqc.org.uk

Write to us

at:

Care Quality Commission

Citygate

Gallowgate

Newcastle upon Tyne

NE1 4PA

Website: www.cqc.org.uk

Copyright Copyright © (2011) 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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