Care Home: Bridgewood Mews

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What the care home does well There are no rigid rules or routines in the home. People living in the home have access to a range of Health and Social Care Professionals to ensure that any health care needs are met. Visiting to the home is open and people living within the home can maintain relationships that are important to them. People living at the home are able to personalise their bedrooms to reflect their individual tastes, age, gender and culture so that they feel comfortable in their surroundings. There was good interaction noted between staff and people living in the home. The home was clean and visitors were welcomed to the home. People living at the home had a comprehensive assessment of their health needs prior to their admission to the home. People living at the home are accessing the community either in the homes own mini bus or out on foot or in wheelchairs with staff. What has improved since the last inspection? Recommendations made at the previous key inspection visit have been met. What the care home could do better: Medication room temperatures must be reviewed to ensure that medication is stored at all times in an environment that is suitable to ensure its stability. Staff need training to update them in a number of areas to ensure they have the skills and competencies that are in line with current thinking to meet the needs of people living in the home. All records pertaining to staff recruitment must be available for inspection. A comprehensive set of records needs to be available so the home can demonstrate with ease how much money is being held on behalf of each person living in the home. A review of activities needs to be undertaken to ensure they are fully meeting the individual needs and preferences of people living at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Bridgewood Mews 38 Bridge Road Tipton West Midlands DY4 0JW     The quality rating for this care home is:   three star excellent 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: Karen Thompson     Date: 1 3 0 5 2 0 1 0 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 Adults (18-65 years) Page 2 of 28 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 Adults (18-65 years) 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Bridgewood Mews 38 Bridge Road Tipton West Midlands DY4 0JW 01215225780 01215225781 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bridgewood Health Care Ltd Name of registered manager (if applicable) Ms Kathleen Felton Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 20 Date of last inspection Brief description of the care home Bridgewood Mews is a purpose built home and can accommodate up to 20 younger adults who are physically disabled and may require nursing care. Accommodation is on two floors, each floor having a lounge, dining room and a further quiet lounge. Peoples bedrooms are on both floors. There is access to the first floor by a passenger shaft lift. All bedrooms are single occupancy, each with en-suite facilities consisting of toilet, hand basin and shower. The main kitchen is on the ground floor with the laundry on the first floor. The home is privately owned by Bridgewood Mews Healthcare. The Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 20 Brief description of the care home home is situated a mile from Great Bridge and is easily accessible via public transport route to local areas, Dudley and West Bromwich. The home has an experienced Manager. There is a registered nurse on duty on each floor twenty-four hours a day assisted by a team of care staff. Fees vary between £1,103 and £1899 and are dependant on the needs of the service user. For up to date fee information the public are advised to contact the home directly Care Homes for Adults (18-65 years) Page 5 of 28 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection so the home did not know we were coming. It was carried out by one inspector over a two day period. The focus of the inspection undertaken by us is upon outcomes for people who live in the home and their views of the service provided. The process considers the care homes capacity to meet the regulatory requirments, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home. We were supported throughout the inspection process by staff at the home. At the time of inspection twenty people were living at the home. Information was by speaking to and observing people who lived at the home. Two people were case Care Homes for Adults (18-65 years) Page 6 of 28 tracked and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people in order to focus on outcomes. Case tracking helps us understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. Care Homes for Adults (18-65 years) Page 7 of 28 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 28 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Peoples needs are assessed before they move in, so they can be confident that their needs will be met upon moving into the home. Evidence: There were twenty people living in the home at the time of our inspection. The files of three people living at the home were looked at in detail. We found all contained a needs assessment undertaken by a senior member of staff. We looked at the Service User Guide and Statement of Purpose. The Service User Guide did not contain the range of fees and the guide was not in a formate that would be accessible to all people living in the home. Relatives confirmed that they had been able to visit the home prior to admission to the home. The home does not provide intermediate care. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Care plans demonstrated that needs and risks were assessed and changes in care were implemented in a timely manner. Evidence: People living at the home had a plan of care which identifies their needs and gives staff instructions on how their needs will be met. These plans included risk assessments. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well-being promoted. Risk assessments consisted of individual and generic risk assessments, including pressure area relief, falls, manual handling and bedrails. People were being weighed regularly and concerns were identified with the appropriate action and liasaon with external professionals had taken place. Staff support people living at the home to make choices and decisions whenever possible. Staff support and facilitate peoples right to make decisions over their life Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: unless a restriction in choice or personal freedom is deemed necessary by a risk assessment. On the first day of our inspection visit people living at the home were being assisted to visit the polling station to cast their vote in the national and local elections. Staff had recently attended a British Sign Language course to help them meet the needs of people living in the home. Staff were keen to master this method of communicating and were seen during the inspection trying to communicate via this method. The home specialises in meeting the needs of people with neurological disorders or acquired brain injury. They are supported to meet the needs of people living at the home by a number of multidisciplinary health care professionals who visit and advise staff on how to meet peoples needs. A number of people living at the home manage their own money with some having the support of staff and their families to manager their own finances. We checked a selection of financial records for people whose money was held by the home. Records were available along with receipts to demonstrate what money has been spent on. We raised concerns with the management team about one persons financial transactions which led the management team to raise a safeguarding referral. Money is being held in a bank account opened by the home for a number of people living at the home. The money is pooled and the homes management team were in the process of trying to establish how much each person was entitled to out of this account. Comprehensive records were not available to demonstrate what belonged to which person. Whilst the home is in the process of trying to resolve this it is concerning that this has ever been allowed to occur in the first place. The home trys to ensure that people maintain their independence and quality of life for as long as possible such as their ability to walk or eat normal foods. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People, who live in the home are encouraged to excercise choice and control over their lives, access the local community and maintain and develop relationships with their families and friends. Evidence: We looked at records of people living in the home to establish that people are taking part in activities that they enjoy. We received mixed feedback about the appropriateness of some of the activities that were on offer to people living at the home. The home has a mini bus which is used daily to take people out. The home has two activities co-ordinaters which ensure that activities can be provided seven days a week. Family and friends are welcomed to the home and those spoken to confirmed that they could visit at any time. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: We observed staff interaction with people living at the home. Staff addressed people appropriately and they were given choices. Staff were observed to knock on peoples bedrooms prior to entering the room. The dining rooms on both floors of the home were pleasantly furnished. We also observed that staff provided appropriate assistance where required at meal times. Snacks and drinks are available outside main kitchen hours. Staff were able to tell us how individual nutritional needs were met. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home recieve sensitive care that meets their personal and healthcare needs and is person centred. Evidence: There is a mixed group of people living at the home in respect of age, gender and ability. Observations made during the inspection confirmed that peoples privacy and dignity is respected. Everyone living at the home was registered with a local General Practitioner (G.P). There was evidence of visits to/from health and social care professionals such as chiropodists, dentists, specialist medical consultant teams, opticians, denticians and specialist nurses. Care plans provided comprehensive information about the support people required with personal care and health needs. We looked at the arrangements in place for medication management. Medication is stored in two trollies in a locked room on both floors of the home. Copies of Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: prescriptions are retained so that staff can check the right medication has been received from the chemist. Medication in a number of instances is adminstered via the Percutaneous Endoscopic Gastrotomy (PEG) lines. PEG routes are made by a surgical procedure which puts a line into the abdomen so that someone who is having difficulty swallowing can recieve nutrition and medication via this route. The staff could demonstrate that they had contacted an appropriate drug information service to reduce any risk of complications or adverse effects from medication administered via the PEG route. The downstair room where medication is stored felt warm and on some occassions exceeded 25c. We sat in this room for well over an hour and despite the air conditioning being on the room was still recording a temperature of 26c on the wall thermometer. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to robust and effective complaints procedure, and are protected from abuse, neglect and self harm. Evidence: The home has an open culture that allows people living at the home to express their views and concerns in a safe and understanding evironment. One relative spoken to saidconcerns are sorted out on the floor, can go to manager, know how to complaint...kept informed of any changes. The home has a complaint log and all concerns were seen to be proactively managed with complainants assured of appropriate actions and required actions undertaken when required. The home has appropriate policies and procedures to safeguard people living at the home from harm and potential abuse and ensure that referrals are made to the required agencies. During the visit we asked for the home to make a safeguarding referral due to concerns that were identified which they did. Staff training in safeguarding has slipped, however staff knowledge in relation to safeguarding and what was required meet the standard. Staff have not received training in the Mental Capacity Act and Deprivation of Liberty. The Mental Capacity Act is an important piece of legislation and it impacts on how care needs to be delivered to ensure people living at the home are not exposed to unlawful restriction. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: We saw inventories of peoples belongings on their care files. This ensures peoples personal items are protected. We saw records for management of peoples personal finances. Care Homes for Adults (18-65 years) Page 19 of 28 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 clean, safe and comfortable home, which promotes their well being. Evidence: The home was purpose built as a nursing home and is well maintained. The home has two floors with bedrooms, lounges, dining rooms and a quiet lounge on each floor. All bedrooms are single and ensuite. People who live there may choose either a double or single bed and are encouraged to bring in personsal items. This ensures bedrooms reflect individual tastes, gender and cultural preferences. All areas of the home seen were clean and welcoming. The home has a wide variety of specialist equipment to care for dependent people whilst also maximising their independence. There is a bathroom on each floor with both having an assisted bath. The assisted bathing facility on the second floor has specialist lighting which provides a sensory atmosphere to the bathroom. All bedrooms have an ensuite with a walk in shower that can be used by people in a chair if required as well as their own toilet. Staff undertake a comprehensive assessment of the needs of people living in the home which includes an assessment of equipment required, to ensure all required equipment is made available to them. A passenger shaft lift enables people to access both floors. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The laundry was found to be clean and well organised with the appropriate machinery to ensure clothes are laundered to a high standard. There are appropriate infection control systems in place. Care Homes for Adults (18-65 years) Page 21 of 28 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff at the home are skilled and are available to meet the needs of people living in the home. Staff training systems are in place but work is required to ensure that staff receive training in a timely manner. Recruitment procedures are robust to protect people from harm. Evidence: There is at least one trained nurse on each floor supported by a team of care staff. Staff spoken to were happy and ethusiatic about working at the home. Staff were able to demonstrate they knew the needs of the people that lived in the home. Figures supplied by the home demonstrate that 83 of care staff have a minimum of National Vocational Qualification (NVQ) level two or above. Staff are receiving supervision. The home was able to demonstrate this was taking place on a regular basis. Staff keep their own staff supervision files. Two members of staff supervision folders were looked at and these meet the standard. The supervision records demonstrated that staff are supported in their role to met the needs of people living in the home. The Care Manager confirmed that staff do recieve induction training and certificates Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: were on file to demonstrate training had taken place during an induction periodl At the time of the inspection permission had not been granted by us for the organisation to keep the Criminal Record Bureau checks (CRB) at their head office. Staff CRBs were looked at following the key inspection and with the rest of the recruitment paperwork it could be demonstrated that recruitment met the standard. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 interest of people living there. Systems are in place to ensure the health, safety and protection of people living in the home. Evidence: The home has an effective management team. There is an experienced Registered Manager who is a registered nurse and has several years of care home experience. The Registered Manager has managed the home since it opened and demonstrated a good understanding of the needs of the people living in the home. Staff and visitors told us that the Registered Manager was approachable and they could discuss any concerns. The home has a quality assurance system in place. The Registered Manager conducts monthly audits of accident, complaints and pressure sores. The home has good health and safety support from its head office, who also undertake checks on the home and provide the Registered Manager with advice when required. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: There was evidence that health and safety maintenance checks had been undertaken. We looked at the gas safety certificate, emergency lighting, lift and hoist safety certificates. The home was awaiting a certificate to demonstrate the fire alarm system had been tested recently and meet the required standard. Records identify that staff attended mandatory training but there were a number of areas such as health and safety, COSHH, food hygiene,infection control, safeguarding, first aid and management of behaviour that challenges that require staff updates. Care Homes for Adults (18-65 years) Page 25 of 28 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 Adults (18-65 years) Page 26 of 28 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 20 13 All medicine must be stored in compliance with their product licence. To ensure their stability. 18/06/2010 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 1 The home should explore alternative formats for the Service User Guide and Statement of Purpose so that information is available in a variety mediums. The Service User Guide should also contain the range of fees the home charges. The activities provided in the home should be reviewed to ensure that they are appropriate for the age and cultural needs of people living in the home. It is recommended that the home obtain a copy of the Departments of Health guidance Mental Capacity Act 2005 core training set published July 2007 and staff are provided with training so that staff are aware of their responsibilities and peoples rights are protected. The home should carry out a review of training needs and from this implement a training programme to ensure that all staff have up to date skills and competencies. Page 27 of 28 2 12 3 23 4 35 Care Homes for Adults (18-65 years) 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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