Care Home: Milverton Nursing Home

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What the care home does well `It`s a very good home - I`d recommend it to anyone`, `You only have to ask - it`s incredible`, `I like it`, `I`m quite happy` and `really lovely` were comments from people who live there. Individuals who returned surveys said `everything is excellent`, `the staff work very hard`, `there is a friendly and homely atmosphere` and `they keep my relative very clean and well dressed`. Feedback about the food provided was very positive. The standard of food provided has clearly improved under the new chef. The environment is very well maintained and people living there have clearly benefited from the substantial renovations that have recently been completed. The new extension provides spacious lounge and dining space with good access to the garden. What has improved since the last inspection? One person who returned a survey said `I sense the general atmosphere in the home has improved as new staff have been appointed`. We think that the manager and staff have made good progress over the past year. The physical environment of Milverton has improved significantly along with the care provided. The staff are much less task orientated and there is clearly more emphasis being put on quality of life for the people living there. The training provided to staff has improved and people feel well supported by the management team. What the care home could do better: The home needs to continue to build on what has been achieved over the past year. Care planning could be better with each document being made much more individual. Reports completed by staff need to feed into the care planning process to ensure that support is delivered as the person likes it and the things that work well with people are recognised. The emphasis on quality of life and wellbeing for each person living at Milverton needs to continue. One staff member said in a survey that `I think we need to make sure we spread our time as evenly as possible with all residents`. We talked to the manager and activities organiser about making sure that staff are engaging with everybody and this is particularly important where someone has dementia or limited communication. The home needs to be reaching people using creative methods including sensory work. The staff training programme needs to be extended to include more specialist training around working with people with dementia and promoting quality of life through interaction and engagement. The Eden training should continue as this will help to keep developing a person centred culture within the service. Key inspection report Care homes for older people Name: Address: Milverton Nursing Home 99 Ditton Road Surbiton Surrey KT6 6RJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jon Fry     Date: 1 2 0 4 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 Older People 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 Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 Older People Page 3 of 28 Information about the care home Name of care home: Address: Milverton Nursing Home 99 Ditton Road Surbiton Surrey KT6 6RJ 02083994663 02083994663 milvertonhome@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Surbiton Care Home Limited Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 31 The Registered Person may provide the following categories 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: Old Age, not falling within any other category - Code OP Physical Disability - Code PD Dementia Code DE (maximum number of places: 10) Date of last inspection 1 7 1 2 2 0 0 9 10 0 31 Over 65 0 31 0 Care Homes for Older People Page 4 of 28 Brief description of the care home Milverton provides nursing care for up to thirty-one older people, ten of whom may have dementia. The home is in a residential area of Surbiton near to shops and public transport links. Accommodation is provided within a mixture of single and shared rooms on the ground and first floor. There are lifts to both upper floors within the home. Care Homes for Older People 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We spent just over six hours at the home and spoke to nine people who live there, three relatives, two members of staff, the manager and the owner. Completed surveys were received from nine people who live there and ten members of staff. A specialist pharmacist inspector carried out a full audit of medication as part of this inspection visit. Care Homes for Older People Page 6 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 Care Homes for Older People Page 7 of 28 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Full assessments are completed to ensure that the home can meet a persons individual needs. Evidence: A new brochure has been produced about the home titled Your guide to our services. This includes photographs of daily life at the home and gives good information about the service provided. The guide includes information about how to make a complaint and that any issues will be responded to within twenty eight days. The name and address of the Commission needs to be updated within this Guide. We looked at three assessments that were completed for three people now living at the home. Each assessment was fully completed and recorded some good information about the person and their support needs. One person told us that the manager had come to visit them in hospital and had asked them about their interests. The information gained had been used to start a weekly group within the home where the Care Homes for Older People Page 10 of 28 Evidence: person was able to pursue their interest with others. This is a good example of working in a person centred way and the home should continue to develop this way of working. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication administration systems have improved. Care plans could still be made more detailed and personalised. Evidence: They are definitely looking after me well, everybody is so kind, Im quite happy and happy were all comments from people who live there. Three relatives or friends of individuals we spoke to during our visit all said they were happy with the service being provided. The three care plans we looked at varied in quality and the manager showed us the templates that he is working on to make each document much more person centred. Some of the care plans we looked at were still too clinical and written in a generic way. Phrases such as shower once or twice weekly as required need to be looked at. The care plan needs to say when the person prefers to have a shower, what time of day, where this is to be facilitated, how the person likes to be supported and by who numbers, gender etc. Care Homes for Older People Page 12 of 28 Evidence: As stated previously, the assessment process used by the service captures some good information about individuals. We think that the home could use this information much more within each persons plan and focus in more on areas such as what makes a good day for the individual. There was some really good information recorded in one persons file about their favourite things but this was not being formally used to inform the care plan and the daily support being provided. The purpose and content of daily notes kept by staff should be reviewed. The notes we looked at were repetitive and too general in content. Daily notes need to be useful in order to keep the care plan up to date. More information about what works well and what doesnt when supporting an individual could help to tailor the support provided. Assessments around health needs are completed and we saw that these were up to date on all three files we looked at. Records such as food and fluid charts are being better kept and we saw that referrals to healthcare professionals take place as required. At the last inspection, we left an immediate requirement due to discrepancies found between medicines held in stock and records of medicines given. This discrepancy meant that we could not confirm that medicines were being given as prescribed. At this inspection, we looked at records of medicines received, used and disposed of, to see whether record keeping had improved, and we carried out an audit of prescribed medicines in stock to see if the home was able to account for the use of medicines. We also inspected medicines storage areas. The outcome for residents is that they are receiving the right medicines on time but recording keeping must be improved. We identified one instance where five residents had missed between two and four doses of their medicines in April 2010 as the prescriptions had been delayed in the post. All medicines were now available. We discussed the reasons for this with the Manager and one member of staff responsible for medicines and we were told that this was the first time the prescriptions had arrived late. We looked at medicines records for previous months, and didnt see any evidence of any medicines unavailable, so this may have been a one-off issue, however the home must make sure that effective arrangements are put in place for the ordering of medicines to prevent people from missing medicines, which could have affected their health. We found that the daily medication audits were now effective in picking up errors Care Homes for Older People Page 13 of 28 Evidence: when staff have forgotten to sign the medicines record however the number of missing signatures picked up during daily audits must be reduced. The audit of 11th April 2010 showed that there were twenty missing signatures that day, which means staff are sometimes signing for giving medicines at the end of the medicines round, or even later in the day, instead of signing directly after giving medicines. Staff must sign the record promptly when they give medication. We found that records of medicines received are being recorded in a separate log. Staff record the quantities of all medicines coming into the home, except for blisterpacked medicines. The Manager said he did not realise these needed to be recorded, as staff assumed the quantities supplied in blister-packs were correct. The quantities received of all medicines must be recorded. Without recording this, staff will be unable to properly account for all medicines held. Other improvements are needed on records e.g. creams dont always have full instructions for use, the area to be applied to and how often they should be applied, and staff have made some amendments to records but havent signed to say who has made the change and when. All prescribed medicines must have full instructions for use, and any changes should be signed and dated. One persons medicines record says none known for allergies. There is a post-it note attached to the record, dated 09 October 2009, which says this person is allergic to penicillin. This is risky as the post-it note could become detached, leaving the person at risk of being prescribed something they are allergic to. One person has arthritis and is not able to communicate verbally. This person has not been prescribed any pain relieving medicines according to their chart. On inspection of their care plan, the GPs notes mentioned that analgesia was needed in January 2009 and again in June 2009. The Manager said that this was not needed for their arthritis, but for pain from bruising. As this person cant communicate their pain, it is recommended that a pain assessment is carried out, so that staff can recognise when this person is in pain, and pain relieving medicines can be prescribed if needed. Controlled drugs are stored securely. We checked the controlled drugs register and found that entries were accurate, and tallied with the quantities of controlled drugs held. There is secure storage for medicines, in a locked clinical room, however the medicines trolley is sometimes left in the hallway. If the medicines trolley is kept in a public area, it should be secured to the wall. Care Homes for Older People Page 14 of 28 Evidence: Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A good range of activities are on offer at Milverton. The people who live there enjoy the food provided to them. Evidence: Comments from people who live there incuded all sorts of things going on, we have exercise therapy twice a week, the library comes once a month and we could still have more going on. Out of the nine surveys received, five people said the home usually provided activities they could take part in with three people saying always and one person said sometimes. We saw flower arranging sessions happening on the day we visited as well as some ball games on the outside patio. Some staff spent time talking and reading books with people and there were many visitors dropping in throughout the day. Planned events for April included music sessions, a tea party at a local Church, visiting entertainers and a Religious service. The management have made adjustments to the shift pattern since our December 2009 visit that means that staff have more time to spend with the people living there. The activities organiser works for thirty hours each week and a visiting person runs an Care Homes for Older People Page 16 of 28 Evidence: exercise session twice weekly. The manager and three members of staff have now attended the Eden training provided through the Local Authority. Further staff members will be attending this training and the manager satetd that he intends to run workshops within the home to make sure that all staff understand this approach. We discussed plans for the future with the activities organiser and recommend that approaches are also developed for people who have dementia or are unable to communicate. It is important that the home looks at how much time staff are spending with each individual and developing approaches to help staff engage with them. feedback about the food provided was very positive. Comments included the food has improved alot, the chef comes to ask me what I want, beautiful and very good. Comments in surveys included the menus are very good and the menus acan be repetitive. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously by the service. Staff have Safeguarding training to help protect the people who live at Milverton. Evidence: Comments from people who live there included any problems, Id talk to the manager, Id talk to the owner or manager and any problems are sorted out. Eight out of nine people who returned surveys said that they knew how to make a complaint. The AQAA told us that Milverton has a simple, clear and accessible complaints procedure which specifies the stages and timescales for the process of how complaints may be made and who will deal with them, with an assurance that they will be responded to promptly and effectively within a maximum of 28 days. The guide to the home includes the complaints procedure. As stated previously the name and address of the Care Quality Commission needs to be updated within this document. The manager told us that there have been no complaints received since our last inspection took place in December 2009. One issue had been recently raised within a review meeting and this had been refeerred to the Local Authority. Care Homes for Older People Page 18 of 28 Evidence: We saw that staff have attended training around Safeguarding Adults in the last quarter of 2009 and the manager stated that this mandatory training would be refreshed in 2010. New starters have this important training as part of their induction. Care Homes for Older People 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, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Milverton provides clean, comfortable and homely accommodation. Evidence: Always clean and tidy, a homely atmosphere and provides a pleasant environment and garden where residents can walk were comments in returned surveys. One person said they would like better ramp access to the garden. People we spoke to were happy with their bedroom accommodation and liked the new spacious lounge and dining area. The internal renovations are now complete and the accommodation throughout provides well maintained comfortable and homely accommodation. Lift access is now provided to all floors. Decking areas in the rear garden provide very pleasant outside space for people to spend time and the manager told us of further plans to provide raised beds for people to take an active part in gardening. The home was clean and hygienic on the day we visited. Care Homes for Older People Page 20 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 staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Full recruitment checks place to help protect the people living at Milverton. Care staff receive satisfactory training to help them do their jobs. Evidence: The people who live there said Id recommend the staff here, the staff are excellent, the staff are nice and so many of them, nice people and the staff are very good. Comments in surveys included they have great sense of humour and also have sensitivity, there appears to be more co-operation between staff and all the staff are very kind. Staffing levels were good at the time we visited and people we spoke to felt there were generally enough staff to meet their needs. The home has re-organised shift patterns and provided one extra carer during the day since our visit in December 2009. The AQAA stated that the majority of care staff working in Milverton have completed their NVQ level 2 in Health & Social Care and are being encourages to pursue NVQ level 3. Some of the care staff working in Milverton who do not have their NVQ level 2 in Health & Social Care, are qualified Nurses or Doctors from their country of origin. Training provided to staff includes Safeguarding, Fire Safety, First Aid, Moving and Care Homes for Older People Page 21 of 28 Evidence: Handling and Infection control. The manager has also facilitated training around person centred care to help develop the right ethos within the service. Four staff have now attended the Local Authority Eden training that should help to support a positive person centred culture within the home. As stated within our December 2009 report, we recommend that the home keep developing the training provided. The manager told us of plans to develop more training around dementia as well as getting more staff to access Eden training. An external professional is also due to give staff some specialist training in April. We looked at the recruitment records for three members of staff. These were very well maintained and contained all the checks required to help protect the welfare of people living at Milverton. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provided at Milverton has benefited from having stable and experienced management. Health and Safety checks take place to keep people safe. Evidence: Comments from staff included good interpersonal relationships between all staff, the management are supportive and the home has improved recently. All ten staff members who returned surveys said that the manager met with them regularly and gave them the support they required. The AQAA reported that The manager is a first level registered nurse in Mental Health and Adult General Nursing, competent and experienced to run Milverton and meet its stated purpose, aims and objectives. The manager worked in the NHS before as a Charge Nurse and has at least 2 years experience in a senior management capacity. The manager is due to complete his NVQ Level 5 in management at Kingston College. The manager has applied to be registered with the Care Quality Commission. We think Care Homes for Older People Page 23 of 28 Evidence: that the service has clearly improved over the last year and the service should seek to continue building on this success. The home sends out annual questionnairres to the people who live there and their representatives to seek their views about the service provided. The manager told us that a relatives meeting was being arranged within the next month. We saw that Health and safety checks take place to keep people safe. Records we saw confirmed that Fire points and hot water outlets are checked weekly to make sure that people are kept safe. Care Homes for Older People Page 24 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 Older People Page 25 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 9 13 Full records must be kept of the quantities of all medications received into the home and being disposed of. To ensure that accurate medication audits can be carried out when required. 21/05/2010 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 2 1 7 The name and address of the Care Quality Commission needs to be updated within the guide about the home. The daily notes written by care staff should be reviewed and discussed. Notes kept by staff should be useful in informing the plan of care and making sure that the support is tailored to the individual. The home needs to continue developing the care plans to be more detailed and personalised to the individual. More focus needs to be put on quality of life and making each day different. Pain assessments should be carried out to identify is pain 3 7 4 9 Care Homes for Older People Page 26 of 28 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 relieving medication is required. 5 9 All creams should have full instructions for use including the area they are to be applied to and how they are to be applied. Any changes on the administration record should be signed and dated. A lock should be provided to secure the medication trolley to the wall if this equipment is routinely being kept in the ground floor hallway. We recommend that the home keep developing the activities on offer. Increasing Engagement and levels of wellbeing should be prioritised by care staff. Individual approaches for people who have dementia should be developed and interation tiime with staff monitored. The home should continue to develop the training programme on offer. This should include more training around dementia and working in a person centred way. 6 11 7 12 8 30 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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