Care Home: Obelisk House

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What the care home does well Some written information is made available to people in different formats such as large print or pictorial to make it easier for people to access. Care plans seen had been signed by the person or their representative to show that they agreed with what had been written. A staff member was seen spending time sitting with one resident discussing some of the days news stories. One person told us told us that the "food usually good." another commented that the "food is quite decent and you can always have a drink when you want one" There was evidence of people accessing their right to vote. One person told us that, "Staff are kind." another said that "staff are quite genuine" In a survey conducted by the home in November 2008 one hundred per cent of respondents said that they were treated in dignified manner and their privacy was respected. What has improved since the last inspection? We did not make any recommendations or requirements following our last inspection. In the AQAA the manager identified a number of improvements made at the home in the last twelve months including staff training and a major redecoration programme throughout the home. What the care home could do better: Care plans need to be reviewed regularly and updated as required to ensure that they accurately reflect how the staff should be caring for and supporting people. Care plans and assessments relating to the risk of people developing pressure sores must clearly detail any intervention required to reduce the risk to that individual. Advice must be sought from the General Practitioner for anyone who has not been given their medication as prescribed and any advice given must be recorded on the person`s file. Nutritional screening should be undertaken when people first move to the home and then on a regular basis in line with their identified needs to ensure that people`s nutritional needs are being met. The home needs to consult people to determine their interests and preferences and then make arrangements to offer access to a range of suitable social and recreational activities. Staff need to be deployed in sufficent numbers to ensure that people`s needs can be met. Key inspection report Care homes for older people Name: Address: Obelisk House Obelisk Rise Kingsthorpe Northampton NN2 8SA     The quality rating for this care home is:   one star adequate 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: Catherine Perrins     Date: 2 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Obelisk House Obelisk Rise Kingsthorpe Northampton NN2 8SA 01604850910 01604850912 fwhite@northamtonshire.gov.uk www.northamptonshire.gov.uk Northamptonshire County Council care home 44 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: 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: No person falling within the DE(E) category can be admitted where there are already 22 people of DE(E) category already in the Home. No person falling within the OP category can be admitted where there are already 44 people of OP category already in the Home. No person falling within the PD(E) category can be admitted where there are already 8 people of PD(E) category already in the Home. The Home may continue to provide care for 1 exisiting named Service User within the category SI (E) The Home may continue to provide care for 3 existing named Service Users who have additional Mental Health needs within the category of MD(E) Total number of Service Users in the home must not exceed 44. Date of last inspection Care Homes for Older People Page 4 of 26 Over 65 22 44 8 0 0 0 Brief description of the care home Obelisk House is a residential care home providing personal care for up to 44 older people, including 22 people with dementia and 8 people with physical disabilities. The home has additional conditions to be able to continue providing care for 3 people who also have mental health or sensory impairment needs. The home is owned by Northamptonshire County Council. The home is situated in a residential suburb of north Northampton, near to local shops and easily reached by public transport. The premises are set back from the road and offer all ground floor accommodation. There are four self-contained units with their own lounge / dining rooms, bedrooms and bathing and toilet facilities. All bedrooms are single. There is also a central lounge area by the entrance, which offers additional seating. Financial assessments are carried out by the County Council to determine charges. The basic charge is 450 pounds per week. Extra charges, not covered by the fees, include services such as chiropody and hairdressing. People are also responsible for charges for newspapers, toiletries and transporting costs for taxis. Further information can be obtained in the homes statement of purpose and service user guide available on request from the home. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection which means that we focused on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for residents. As part of the preparation for this inspection a period of four hours was spent reviewing the information that CQC has about this service. We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. Care Homes for Older People Page 6 of 26 The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service and from other people with an interest in the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. The inspection visit lasted six hours during the morning and afternoon of a weekday. During the inspection three people were case tracked. This involves looking in detail at all aspects of their care and experiences at the Obelisk House, including looking as their individual plans of care and other records, talking to them and talking to their care staff. Because people with dementia are not always able to tell us about their experiences we also used observations of peoples state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. The registered manager was not present for the inspection as she was on leave. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Care plans need to be reviewed regularly and updated as required to ensure that they accurately reflect how the staff should be caring for and supporting people. Care plans and assessments relating to the risk of people developing pressure sores must clearly detail any intervention required to reduce the risk to that individual. Advice must be sought from the General Practitioner for anyone who has not been given their medication as prescribed and any advice given must be recorded on the persons file. Nutritional screening should be undertaken when people first move to the home and then on a regular basis in line with their identified needs to ensure that peoples nutritional needs are being met. The home needs to consult people to determine their interests and preferences and then make arrangements to offer access to a range of suitable social and recreational activities. Staff need to be deployed in sufficent numbers to ensure that peoples needs can be met. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given good information and their needs assessed to ensure that the home is right for them. Evidence: The home has a statement of purpose which gives people good information about the home and the services it offers. There is also a service user guide which is available in large print and in a pictorial format to make the information accessible to older people who may have difficulty reading ordinary print and to people with dementia. Copies of the statement of purpose and service user guide are on display in the central area of the home and so can be accessed by people living at the home and visitors. Records show that people are thoroughly assessed before they move in to the home to ensure that the home can meet their needs. One person told us that her relatives visited the home on her behalf to ensure that the home was right for her. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are generally well met. Evidence: Each person who lives at the home has an individual plan of care. This contains their care plans and other information that staff need to care for people in the right way. Care plans seen covered areas such as personal care, mobility, communication, hearing, sight, orientation, emotional needs, hobbies and interests, religious and cultural needs and sleep. They contained some detail about peoples preferences such as peoples preferred name and what time they liked to get up and go to bed. There was some evidence of people being helped to make choices such as what clothes they wanted to wear and what they wanted to eat. Care plans seen had been signed by the person or their representative to show that they agreed with what had been written. We looked at two care plans for people in the dementia units of the home. One person did not have a specific dementia care care plan, staff told us that he had mild dementia. The other person did have a sprecific dementia care plan but there was no Care Homes for Older People Page 12 of 26 Evidence: evidence of it being updated for more than two years. One person had been identified as being at risk of pressure sores. The pressure care assessment on her file was very general and did not give detail of her individual needs. For example it stated to use pressure equipment as required but did not detail which, if any, equipment was required or how it should be used; There was however, evidence that where people have pressure area needs advice is sought from district nurses who visit to treat people and arrange pressure relieving equipment as required. Records showed that staff were recording any marks or pressure areas and that they were also monitoring peoples fluid intake where it was identified as being required. Recognised assessments and screening tools are used to assess people for the risk of falls, moving and handling and nutrition. One of the people that we case tracked had diet controlled diabetes. The nutritional profile and assessment in her file had not been completed. The home keeps records to show when people take baths. Records show that some people had not had a bath on occassions for two weeks at a time. Staff explained that people are offered a bath on a weekly basis but sometimes do not want one, and that people are able to have baths more frequently than once a week if there is enough staff to give them any assistance that they may require. Records show that people have access to a range of health professionals such as consultants, general practitioners, dentists, opticians, community psychiatric nurses and district nurses as determined by their health needs. In a survey conducted by the home in November 2008 one hundred per cent of respondents said that they were treated in dignified manner and their privacy was respected. We looked at the Medication Administration Record. Some people had not received their medication as prescribed on several occassions over the previous month because they had been asleep at the time when their medication should have been given. There was no record of advice being sought from the persons general practitioner or pharmacist regarding this matter. We issued an immediate requirement to the home to seek advice from the general practitioner for anyone who has missed their prescribed medication. We issue immediate requirements when there is an immediate risk to the people living at the home that requires urgent attention to ensure peoples safety and well being. When this matter was brought to the attention of staff appropriate action was taken to ensure that people were safe and receiving their Care Homes for Older People Page 13 of 26 Evidence: medication as prescribed. A spot check on one persons medication showed that the total number of tablets did not correspond with what was recorded on the Medication Administration Record. Staff told us that the balance of tablets from the previous months recording sheet had not been carried forward. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have some control over their daily routines and have the choice of various social activities within the home each week. Evidence: Peoples individual plans of care did contain some information about their interests and hobbies. Activities sheets were seen which contained a record of the activities that people had taken part in such as listening to music, bingo and exercises. Some people had several days gap between entries in their activity log. On the the day of inspection staff were observed playing a game of hoopla in one of the units with residents. In the other units people were seen watching the television or listening to music. Newspapers and books were also available. A staff member was seen spending time sitting with one resident discussing some of the days news stories. Staff told us that a church service is held in the home every two weeks for anyone who wishes to attend. People gave us mixed feedback about the activities on offer. One person told us Care Homes for Older People Page 15 of 26 Evidence: Sometimes we have a singer come in. others told us there were not any activities that they could take part in. A relative told us that there was no stimulation during the day. Lunch was observed during the inspection. Staff were seen assisting people in sensitive manner, talking to them and explaining what the food was. One person told us told us that the food usually good. another commented that the food is quite decent and you can always have a drink when you want one The menus were seen and looked varied and nutritious. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes policies, procedures and practices. Evidence: The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. The manager told us that this is available in large print and a pictorial format to make the information more accessible to everyone. People spoken to told us that they would speak to staff or to the manager if they had any concerns. In a survey conducted by the home in November 2008 eighty-one per cent of respondents said that they knew how to make a complaint. Staff spoken to knew how to raise any concerns and were aware of their responsibilities under the locally agreed safeguarding adults procedure. Staff told us that the home has not received any complaints in the twelve months previous to the inspection. Discussions with staff showed that they knew how to raise any concerns that they may have and that they understood their responsibilities under the locally agreed safeguarding adults procedure. There was evidence of people accessing their right to vote. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from comfortable and spacious living environment. Evidence: Obelisk House is a single storey building which comprises on four units. Each of the units leads off from a large communal seating area by the main entrance. Two of the units cater for people with dementia. Each unit has a large lounge / diner with a kitchen area for making drinks, communal bathroom facilities and bedrooms. There is a small smoking room for anyone living at the home who smokes to use if they wish to. Fresh flowers, pictures, ornaments and other effects make the communal areas feel homely and bedrooms seen had been made personal with photographs and other personal items. Each of the bedrooms has a wash basin. All of the units have access to the homes garden areas where there is seated areas for people to sit out and enjoy any warmer weather. The home was observed to be generally well maintained and clean throughout. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a competent and caring staff team of which there are usually adequate numbers to meet peoples needs. Evidence: The recruitment of staff is well managed with all of the necessary pre recruitment checks being carried out to ensure that staff are suitable to work with older people. Staff told us that they had an induction when they first started working at the home which included working alongside an experienced colleague to make sure that they had all of the information that they need to do their job in the right way. Staff explained that they attend training courses such as food hygiene, safeguarding of adults, dementia care, challenging behaviour, infection control, fire safety, bereavement and moving and handling. Staff were observed helping people in a kind and caring manner showing an understanding of their needs and preferences. One person told us that, Staff are kind. another said that staff are quite genuine Staff explained that one member of staff is allocated to each of the four area. An additional staff member works in the area where people have dementia and another Care Homes for Older People Page 19 of 26 Evidence: staff member works where they are needed across the four units. In a survey that we sent out to staff members prior to the inspection we asked whether there are enough staff to meet the individual needs of all of the people in the home. Out of the six people who responded two said always, three usually and one said only sometimes. A relative told us that sometimes call bells are not answered promptly and that sometimes people have to wait to be helped to the toilet. Staff told us that sometimes if they are busy helping another person then someone may have to wait a short while for assistance. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements within the home ensure that people are safe and their needs are generally well met. Evidence: The registered manager of the home holds the Registered Managers Award and a level four and five in management and leadership.She has many years experience of working for Northamptonshire County Council. Records show that the necessary safety checks such as fire checks, checks on the water system and portable appliance testing have all been carried out recently. Hoists and lifting equipment has been serviced as per manufacturers recommendations. Records show that the home carries out a satisfaction survey twice a year. The results were viewed and were generally positive. Staff showed us a pictorial survey that the home are planning to use, this will make it easier for people with dementia to give their feedback on the home. Care Homes for Older People Page 21 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 Advice must be sought from the General Practitioner for anyone who has not been given their medication as prescribed and any advice given must be recorded on the persons file. This is required to ensure the health and well being of the people living at the home. 23/09/2009 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 8 17 Care plans for people with dementia needs to detail how staff should support them with regard to their dementia. To ensure that people get the approriate support to meet their individual needs. 02/11/2009 2 8 17 Care plans and assessments relating to the risk of people developing pressure sores must clearly detail any intervention required to reduce the risk to that individual. 02/11/2009 Care Homes for Older People Page 23 of 26 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 To reduce the risk of people developing pressure sores. 3 8 17 Nutritional screening should be undertaken on admission and subsequently on a periodic basis. To ensure that peoples nutritional needs are being met. 4 8 15 Care plans should be reviewed reguarly and updated as required. To ensure that they accurately reflect how the staff should be caring for and supporting the person. 5 9 13 Arrangements must be made for the accurate recording of peoples medication and that all medication is accounted for. To ensure that people receive their medication safely and as prescribed 6 12 16 The home must consult people to determine their interests and preferences and make arrangements to offer access to a range of suitable activities. 30/11/2009 05/10/2009 01/12/2009 02/11/2009 Care Homes for Older People Page 24 of 26 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 To ensure that people have the opportunity for stimulation and recreation. 7 27 18 Appropriate numbers of staff 30/10/2009 must be deployed to meet the assessed needs of the people living at the home. To ensure the health and welfare of all. 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 Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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