Care Home: Derwen College

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What the care home does well The staff carefully find out what people want to learn while they are at the College.They try to find out what they can eat and if they need any special food. They then provide a wide range of food at each meal-time.They have written down what help you need in paper files and on the computer system that all the staff can look at easily wherever you are in the College.If someone is ill they make sure that they get the right treatment. They have their own medical centre with nurses on duty all of the time. If someone needs medicines or creams they will make sure they get them. If a person doesn`t like something they can tell the staff. If a person who finds it difficult to talk doesn`t like something the staff will notice. If someone is upset and unhappy the staff will try to find out why.The College well maintained and well decorated.Each person can keep their own belongings in their room and those rooms can be decorated with posters, pictures and other ornaments.The College has large grounds which many activities take place in.The staff are cheerful friendly and helpful and encourage people to enjoy themselves but also try to make sure that they are safe and well looked after. What has improved since the last inspection? Since the last inspection more facilities have been added to the College such as the Retail area where people can experience working in shops and a new coffee bar that overlooks the College`s tea plantation. What the care home could do better: Everything is fine. Key inspection report Care homes for adults (18-65 years) Name: Address: Derwen College Derwen College Gobowen Oswestry Shropshire SY11 3JA 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: Michael Moloney Date: 2 4 0 3 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 32 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 32 Information about the care home Name of care home: Address: Derwen College Derwen College Gobowen Oswestry Shropshire SY11 3JA 01691661234 01691670714 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Trustees Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 252 Number of places (if applicable): Under 65 Over 65 252 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 252 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 252 Of the following age range: from the age of sixteen years upwards. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home Derwen College is a college that provides vocational, educational, personal and social development of young people with a wide range of learning difficulties and disabilities. The Director is Mr D J Kendall. The College is in Gobowen, near the town of Oswestry in North Shropshire. It is within easy reach of all community resources and facilities. It is set in 50 acres of parkland, and offers further education, care and accommodation for 252 young people. Care Homes for Adults (18-65 years) Page 5 of 32 The College provides living accommodation in a variety of settings, from purpose built specially equipped residences to smaller flats and bungalows. The College has its own health centre on site. Care Homes for Adults (18-65 years) Page 6 of 32 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 Care Homes for Adults (18-65 years) Page 7 of 32 How we did our inspection: This is what the inspector did when they were at the care home Before we went to the College we looked at the information that they had sent us. We often ask for this before an inspection and always ask the same questions. This tells us how the College thinks it is doing. We also look at the information that the College has sent us about accidents that have happened to people who live and work in there. We also looked at the Colleges Ofsted report which is written by the poeple who look at how well the College teaches people. Two inspectors visited the home. Their names were Mike Moloney and Di Chadwick. They were there for twenty-two hours over two days. Care Homes for Adults (18-65 years) Page 8 of 32 We looked at how eight of the people who go to the College are looked after and what had been written down about them. We talked to lots of the people who go to this College so that they could tell us what they thought about it. We also watched the staff so that we could see how they looked after the students and trainees and talked to them about what they did. What the care home does well The staff carefully find out what people want to learn while they are at the College. Care Homes for Adults (18-65 years) Page 9 of 32 They try to find out what they can eat and if they need any special food. They then provide a wide range of food at each meal-time. They have written down what help you need in paper files and on the computer system that all the staff can look at easily wherever you are in the College. If someone is ill they make sure that they get the right treatment. They have their own medical centre with nurses on duty all of the time. If someone needs medicines or creams they will make sure they get them. If a person doesnt like something they can tell the staff. If a person who finds it difficult to talk doesnt like something the staff will notice. If someone is upset and unhappy the staff will try to find out why. Care Homes for Adults (18-65 years) Page 10 of 32 The College well maintained and well decorated. Each person can keep their own belongings in their room and those rooms can be decorated with posters, pictures and other ornaments. The College has large grounds which many activities take place in. The staff are cheerful friendly and helpful and encourage people to enjoy themselves but also try to make sure that they are safe and well looked after. Care Homes for Adults (18-65 years) Page 11 of 32 What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Care Homes for Adults (18-65 years) Page 12 of 32 Michael Moloney 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 13 of 32 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 14 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective students and their representatives have the information needed to choose the college that will meet their needs. They have their needs assessed and information which clearly tells them about the service the will receive. Evidence: We saw that the college publishes a prospectus each year that provides information to people who are thinking about becoming students there. We looked at the records of three students who were new to the College in this academic year. We saw that the information obtained about the students before they started at the College was comprehensive and obtained from information provided by the placing authority, parents as well as the students themselves. We talked to a number of senior members of staff who told us that the assessment process included not only the educational aspirations of the students but many of their social ones such as where they would like to live and in what type of accommodation. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: We also found that personal care needs were also looked at so that the College could plan what levels of assistance each person would need during their stay. We looked and a number of students records and also talked with a number of the care staff who confirmed that the assessment process is continuous throughout the students stay at the college but it is particularly emphasised during the first term. We talked to some of the students who told us that they had been fully involved in this process. Telling us this confirmed what we had seen in the records kept by their personal tutors. They also confirmed that their preferences had been taken into account when their care plans had been developed. Care Homes for Adults (18-65 years) Page 16 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives and play an active role in planning the care and support they receive. Evidence: We looked at the records of eight of the students. We saw that they contained a number of documents that were kept in both hard copy and in electronic form, with the latter being available to the staff on the colleges intra-net system. We saw care plans and risk assessments that had been developed from the initial assessments and these included such things as road safety issues. As these documents are kept on the college intra-net they are easily accessible to any staff who need to access the information that they contain. We saw staff accessing these records on a number of occasions during the inspection. Looking at the records as well as talking to the student showed that they are regularly updated as the needs and skill levels of the individual changes. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: During the inspection we often heard staff persuading students to take part in activities. This was always done in a sensitive manner and the students reactions suggested that they were used to this approach and considered it to be encouragement. Care Homes for Adults (18-65 years) Page 18 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students and trainees are able to make choices about their life style and are supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: We looked at the files of eight of the students and a large number of the students spoke to us. We saw from the lists on the notice boards that a large number of activities had taken place during February. The students told us that these had been popular and that each month a new list of activities was posted. We looked at the Information Technology block and saw that it was popular with a number of the students who spent some of their leisure time in there. We also saw that the College has a large sports field and the state of the ground showed that it was well used. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: As we went around the college in the evening we saw a large number of the students relaxing either on their own or in small groups in the social centre, the grounds or their accommodation. We talked with a number of the students and the staff who also confirmed that at the weekend they could go shopping in the town. Students who needed support to do so went in small groups with staff on the regular minibus run whilst others who had been assessed as being able to could catch the local public transport. We saw that those assessments were available to staff on the College intra-net system. We could see that there are lots of friendships amongst the students. Talking with the staff told us that they are aware of these and are often asked by the students to give guidance and support about these relationships as the need arose. We talked to a number of the students who told us that they are able to undertake work placements in local businesses as part of their personal development plans and a number of the students spoke of their experiences, particularly in the catering industry. Students told us that they liked the range and quality of the meals that they are offered. Chef confirmed that the variety of dishes continues to expand as the cultural diversity of the student group broadens. He also talked about the wide range of other special dietary needs that the College caters for such as nut and fish allergies. Chef also told us about the training that students receive within the College in both the preparation and serving of food. He told us that training was available up to National Vocational Qualification Level 2 in catering. He is also responsible for all food hygiene training within the College to both students and staff as well as the issuing of the appropriate certificates. Care Homes for Adults (18-65 years) Page 20 of 32 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. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: We looked at the records kept by the care staff in the various accommodation areas and saw that these showed the detailed support needs of the students. We talked to a number of the students and they confirmed that they were receiving that care outlined in their files and were satisfied with it. We also talked to a number of the staff who were on duty during the visit and listening to them showed that they were familiar with the detail contained in the care plans and therefore would be able to meet the students needs. The College has a purpose built health centre that is staffed by qualified nurses on a twenty-four hour basis. Staff confirmed that a doctor holds surgeries most days and responds to medical emergencies out of hours. We saw that medication for the students is overseen from the health centre. Most is kept there but some is kept and administered in Cadbury Court and Acorns. Storage and records in all three locations were seen to be appropriate. The nurses on duty told us that some students are able to manage their own medication Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: with varying levels of help from the staff. Risk assessments had been carried out to make sure that they would receive the right level of help. Care Homes for Adults (18-65 years) Page 22 of 32 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. Students and trainees are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse and have their rights protected. Evidence: We looked at the Colleges complaints procedure. We saw a complaints book that contained the details of any communications about the issues raised and the outcomes of any investigations. We looked at how the head of care was processing a complaint received just before this inspection and we saw that it was being investigated in a thorough and transparent manner. Talking with the students it was clear that should they have issues that they would like to raise many were capable of raising them with the staff either directly or through the Student Council. We saw that there have been no referrals into the local Adult Protection procedures in the last year. We looked at the staff training records which showed that the staff had been trained in the local policies and procedures for the protection and vulnerable adults and we talked with a number of staff who were on duty at the time of the inspection who confirmed this. Care Homes for Adults (18-65 years) Page 23 of 32 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. The physical design and layout of the college enables students and trainees to live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: We saw that both the living and college accommodation on the site is modern, spacious and well maintained, providing a safe environment for students. All of the areas that we saw were clean and tidy and free from any obvious dangers. We saw that the way the College is designed and laid out promotes the privacy, dignity and independence of the students and trainees. All of the bedrooms that we saw were safe and comfortable. Students and trainees told us that they are able to personalise their bedrooms by adding their own pictures, ornaments and equipment which was very obvious from what we saw. The bedrooms, particularly in the main units, were a mix of singles and doubles, some of which had en suite facilities. Students and trainees told us that they are consulted before they are allocated double rooms. When we looked around the College we saw that each area had a fully equipped, properly maintained and hygienic laundry area where the students and trainees clothes, bed linen and towels could be kept clean. Care Homes for Adults (18-65 years) Page 24 of 32 Care Homes for Adults (18-65 years) Page 25 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the college are trained, skilled and in sufficient numbers to support the people who use the service. Evidence: We watched and listened to the staff as they talked with the students and found that they were very sensitive to the needs and wishes of the young people; even those who do not live in the accommodation in which they work. The students told us that they found all of the staff very approachable and sympathetic to their problems. Looking at how the staff worked during the inspection, talking to them and looking at staff rotas in various residential areas showed that staff are available throughout the College in appropriate numbers. Talking with staff also showed that they move from residence to residence should one area require more assistance than was usual. The students told us that staff were always available when they needed them. We looked at the records of a number of staff who had started work at the College since the last inspection. These contained records of the checks necessary to ensure the any person employed to work with the students and trainees was fit to do so. We looked at the staff training records and talking to the staff confirmed that more that 50 of the staff are already qualified to National Vocational Qualification level 2 in care Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: with many being qualified to a higher level. A number of the Heads of Houses have already achieved National Vocational Qualification level 4 in care with others working towards it. The training records also showed that the staff had access to other training such as the mandatory safety training and courses about specific disabilities such as Autism. Care Homes for Adults (18-65 years) Page 27 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the college is based on openness and respect, has effective quality assurance systems developed by a qualified, competent management team. Evidence: We talked to a number of the Heads of Houses during the inspection. Most had already achieved National Vocational Qualification level 4 in care and others were working towards this. A number of the more experienced staff also told us how they were undergoing training to become a Duty Officer who has overall responsibility for the site outside of teaching hours. They are the people who monitor the behaviour and whereabouts of the students with the help of the care staff in the houses. The Head of Care told us that the home was aware of the local procedures that are designed to protect the human rights of people who lack the capacity to do so for themselves. She told us that nobody in the college had any restrictions placed upon them as a result of these. We saw records that showed that the College had looked at which ethnic backgrounds Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: both students and staff came from. We spoke to some of the senior staff who talked about their efforts to ensure that people from all backgrounds were able to come to the college as either students or as members of staff. We also talked to a number of the student who told us about the Student Council which is a committee made up of students that can raise and discuss issues that are important to them. We saw records of their meeting which showed that they talk about such things as the menus available to them, social activities and the general college environment. One example seen was the lack of street lighting on one part of the campus. This had been raised and improved lighting put into place. We were also given copies of the results of surveys carried out by the College and its students into how well they were meeting the needs of the people who go there. We looked at a range of health and safety documentation which we found to be accurate and up to date. We also looked at some of the fire fighting equipment and electrical equipment and the labels showed that all of the testing and checking was up to date and a schedule of routine maintenance is in place. The College has its own on site maintenance team and can call in external contractors if necessary. The College also keeps cash for the students and trainees. One of the finance staff is responsible for the management of the accounts. We looked at the daily cash book, withdrawal receipts and personal allowance account sheets and talked about how they worked with her. She told us that weekly personal allowances are provided to students/trainees every Friday and the allowance is given to them in cash and distributed via the units. The personal allowance is normally £5 but will be increased if someone needs more. Any withdrawals above that personal allowance has to be signed for and the student/trainee has to see the finance officer to obtain it. Receipts are required for all spending. Where students or trainees go on organised college trips, the costs are debited to their account with the college, usually at the end of the month. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes  No  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 30 of 32 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 Description 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 Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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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