Care Home: Wrenbury Nursing Home

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What the care home does well Although nobody new has moved into the home since our previous key inspection there are systems in place to ensure that people`s needs would be assessed before they move into the home in order to ensure that the home will be right for them. The health and personal care needs of the people living at Wrenbury are met by the home`s staff, with input from health professionals as needed. This helps to ensure that the home is able to respond to changing needs, which in turn enables people to maintain as much independence as possible. We found that staff members were positive about the home and were able to demonstrate an awareness of the diverse needs of the people they were supporting. Positive, relaxed and warm relationships were seen to exist between service users, relatives and staff members. Those people that commented all said that the manager and staff members were very good. The visiting relative said; "We looked at a number of homes, when we visited it was friendly. The home is lovely and the staff are brilliant". Routines within the home are flexible. For example, we saw someone having a late breakfast; this gives people some control over their lives and enables them to maintain their independence. A wide choice of meals are offered and the standard of catering is very good. This helps to make sure that people have a varied diet that they enjoy. We consider that the quality assurance survey carried out in November 2009 asks the "right questions", for example, "what can we do better"? What has improved since the last inspection? There have been a number of staffing issues since the previous key inspection. As a consequence of this we undertook a random inspection in November 2009 (a random inspection is a focused inspection that looks at particular issues only). These issues have been addressed and the home is actively trying to recruit new staff and to ensure that the standards are maintained and where possible improved upon. The staff members we spoke to were aware of the problems that had existed and all of them said that they felt they had now been sorted; they all told us, "things are getting better". Improvements to the facilities have been made and the environment has been rated as good rather than as adequate as at the previous key inspection. This has enhanced the facilities for the people living in the home. What the care home could do better: We consider that Wrenbury Nursing Home is a good service. However due to recent staffing issues and a high turnover of staff there are a number of areas that need to be improved. These include improvements to the staff recruitment, induction and training processes. This would help to ensure that people living in the home are supported by properly recruited and trained staff members. Key inspection report Care homes for older people Name: Address: Wrenbury Nursing Home Wrenbury Hall Drive Wrenbury Nantwich Cheshire CW5 8EJ     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: Paul Ramsden     Date: 0 9 0 3 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 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) © 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 26 Information about the care home Name of care home: Address: Wrenbury Nursing Home Wrenbury Hall Drive Wrenbury Nantwich Cheshire CW5 8EJ 01270780114 F/P01270780114 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wrenbury Ltd Name of registered manager (if applicable) Mrs Gaynor York Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The home is registered for a maximum of 33 service users to include: * Up to 33 service users in the category OP (old age, not falling within any other category). * Up to 3 service users in the category PD (physical disability). Date of last inspection Brief description of the care home Wrenbury Nursing Home is a two storey converted detached property situated in its own grounds in a rural area. It is close to the local amenities of Wrenbury village and near to Nantwich town centre. 1 7 1 1 2 0 0 9 0 3 Over 65 33 0 Care Homes for Older People Page 4 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: 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 (the Care Quality Commission) visited Wrenbury Nursing home unannounced on 9 March 2010 as part of this inspection. Two inspectors carried out the visit during which we spoke with some of the people who live at the home, a visiting family member and some members of staff, to find out their views about the home. We walked round the building and looked at all of the bedrooms and communal areas. We checked records kept at the home and spent time talking with the home manager and owner. Any references to we or us in the report refer to the Commission. All of the key standards for older people were looked at. Feedback on the findings of the inspection was given to the home manager and owner at the end of the visit. This visit was just one part of the inspection. Prior to the visit the home manager was asked to complete an Annual Quality Assurance Assessment [AQAA] to provide up to date information about the service provided in the home. This is a very detailed questionnaire that provides us with a lot of information about the service before we go Care Homes for Older People Page 5 of 26 to the home. We looked at the reports of the previous main inspection and short inspection that were carried out in the year before this visit. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: We consider that Wrenbury Nursing Home is a good service. However due to recent staffing issues and a high turnover of staff there are a number of areas that need to be improved. These include improvements to the staff recruitment, induction and training processes. This would help to ensure that people living in the home are supported by properly recruited and trained staff members. Care Homes for Older People Page 7 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 8 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 9 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. Information and opportunities to visit before moving in are available and service users are assessed before moving in to ensure their needs can be met at the home. Evidence: The home provides a range of information to prospective and existing service users; this is presented in a combined service user guide and statement of purpose that is available in the entrance area. This document contains all of the information required and it should provide sufficient information for anyone who is thinking of moving into the home. People are free to visit and look around Wrenbury prior to choosing to live there if they want to. They can also stay for a meal and have a trial visit before deciding. If they have any queries they can contact the manager, owner or another senior staff member. When we visited there were 19 people living in the home. None of the people living at the home had moved in since our last key inspection. Pre-admission documents are Care Homes for Older People Page 10 of 26 Evidence: available and we were able to see that an appropriate assessment had been carried out for for the people whose files were looked at. The manager will usually carry out the assessments and she will visit people in their own home, another care home or hospital to gather the necessary information before confirming that the persons needs can be met at Wrenbury. This provides an opportunity to make sure the home can accommodate the person and their individual needs. Where applicable copies of information provided by the local authority is also obtained before the person moves in. This provides background information as to the reasons why a move to the home is needed and is very useful when combined with the homes own assessment. Intermediate care is not provided at Wrenbury Nursing Home. 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 good 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 needs of the people living at Wrenbury are met by the homes staff with support from healthcare professionals as needed to make sure people stay as well as possible. Evidence: Each person has a care plan that is generated from the information gathered during the assessment. The plans provide the details of the individuals needs, any risks identified and the care that they require. We looked at some of the care plans to see what care people needed and how this was recorded. The care plans seen were all up to date and were written in a style that would enable someone reading them to have a reasonable idea of what help and assistance someone needed at that time. Care plans were being reviewed and where necessary re-written on a regular basis. At the time of our visit two people were very frail and had pressure sores. Although wound charts were in place we did find some gaps in the record for one person and no notes had been made for five days. The manager agreed to address this issue with the nurse responsible. Appropriate pressure relieving equipment was being used for Care Homes for Older People Page 12 of 26 Evidence: people identified as being at risk. During the tour of the building we did see some bed rails that we considered to be fitted incorrectly; they either had gaps that were too small or too big. Bed rails can present a hazard if incorrectly fitted and our opinions were passed on to the maintenance person and the home manager in order for them to take the appropriate action. Staff members spoken with could show that they had a good understanding of the people they were supporting and they were able to meet their diverse needs. Care staff work to a good standard in order to ensure that people who live at the home receive the care they need. One of the people we spoke with told us; the staff are good, they do everything properly and always treat me with respect and dignity. The local GP visits the home each week and also provides an out of hours service. The care plans recorded that people have visits from healthcare professionals as needed. All bedrooms are single rooms and all care and support is carried out with due respect for peoples privacy and dignity. It was seen throughout the visit that people who live at the home were being treated with courtesy, respect and good humour by staff. The people we spoke with during our visit to the home considered that staff were polite and respectful. Wrenbury has a written policy on the receipt, administration, safekeeping, handling, recording and disposal of medication within the home. The arrangements for the administration of medicines during this inspection visit were considered to be good and the service users were being given their medication as prescribed. The home currently orders medication on a weekly basis; this is time consuming and during a discussion with the manager we suggested that less time would be needed if it was done monthly as in the majority of homes. The manager considered that this was a good idea and would look into the practicalities of how this could be done. Care Homes for Older People Page 13 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 who live at the home are able to choose how they spend their time and those spoken with were very positive about the home and the support they received. Evidence: The people living at Wrenbury who we spoke with during our visit confirmed that they were able to move freely around the home and that they were able to make choices in many areas of daily living; for example, times of rising and retiring and where to spend time and with whom. There is a choice of two comfortable lounges or people can spend their time in their own room if they wish. The bedrooms are personalised with peoples own belongings, such as pictures and ornaments, to make them feel more homely. People who we spoke during our visit with expressed their satisfaction with daily living arrangements. A new activities co-ordinator had been appointed and was due to start work shortly after our visit. This job was to work both individually and in groups by providing social and other activities/events. Until the new member of staff started, any activities had to be organised by staff members. A visiting family member told us that some trips, for example Chester Zoo and the Blue Planet, had been organised. This was obviously limited due to time constraints so we think that the appointment of the co-ordinator Care Homes for Older People Page 14 of 26 Evidence: should help to improve the residents quality of life by being able to organise things on a daily basis. The home has contacts with local church groups and a communion service is held monthly in the home. Young people from local schools also visit during the year. The dining room is bright and spacious, and can accommodate all of the people who live at the home. People may have their meals in their own room if they prefer. We looked at the menus, which showed that a good choice is available at all meals. The people we spoke with were happy with the quality and quantity of their meals and staff considered that people receive a nutritious diet. Care Homes for Older People Page 15 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. There are procedures for dealing with complaints and safeguarding issues at the home so people living there are protected from harm and their concerns are listened to and acted upon. Evidence: There is a complaints procedure for the home; this was included in the information given to new residents and their families and was also displayed in the entrance area of the home. The information we were sent from the home before our visit there told us that six complaints had been received by the home in year before our visit. Although we found full records had been kept and that the complaints had been dealt with appropriately we considered that the system could be improved further if an index of complaints was maintained. The manager has been providing safeguarding training for staff, and training records showed that nearly all of the staff have now attended this training. Any safeguarding issues have been reported to social services and this has helped to make sure that the people living at the home are protected from harm. Care Homes for Older People Page 16 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. The home provides clean and comfortable surroundings for people to live in. Evidence: During our visit we walked round the home, including communal areas and all of the bedrooms. The majority of the occupied rooms were personalised, comfortable, well furnished and contained items of furniture belonging to the individual. Wrenbury generally provides a comfortable and homely environment that can meet the needs of the people who live there. We did not see any hygiene or cleanliness issues. Since our previous inspection visit the maintenance person has ensured that all of the bedrooms have had radiator covers fitted. This had been an outstanding requirement from earlier inspections. Improvements to the home continue to be made and since our last main inspection new fire detectors have been fitted, several rooms have had new carpets fitted, and some new beds and wheelchairs have been provided. Aids to help maintain independence, for example a call system and bathing aids, have been provided. We asked why one of the bathrooms on the first floor was not being used; the owner explained that a new bath was due to be fitted; this would be more suitable for residents to use. Care Homes for Older People Page 17 of 26 Evidence: There are fully accessible well maintained garden areas available for residents to use. The laundry within the home is well equipped and good systems are in place for the care of peoples clothes. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The induction, recruitment and training processes in the home need to improve in order to ensure that service users are supported by appropriately recruited and trained staff members. Evidence: The nursing and care staff rotas we looked at showed that whilst there were enough staff members on duty there was a high usage of agency staff. We are aware that the home had experienced a number of staff changes during the period before our visit and that this had caused problems. The owner and manager were working hard to address this and some new staff had been appointed. Recruitment was ongoing and a new activities co-ordinator was due to start shortly after our visit. In order to minimise the disruption to residents until more staff are recruited the home was trying to use the same staff from a single agency. This seemed to be working fairly consistently and the agency carer we spoke to confirmed that she worked regularly at Wrenbury. All of the staff members were seen to be cheerful and friendly and we spoke to a number of them during the visit; they all had a very good understanding of their roles and were knowledgeable about the needs of the people they were supporting. A newly appointed staff member told us; I love my job. The residents and visitor we spoke with were very complimentary about the staff members attitude and competencies. One of the people living in the home said; Staff Care Homes for Older People Page 19 of 26 Evidence: members always speak properly to me, I have no complaints. The nursing staff members employed at the home were undertaking continuous training as part of the professional requirement for them to do so. According to the manager and the information we received before our visit, 26 of the care staff members are either qualified or are working towards a National Vocational Qualification (NVQ) level 2 or 3 in care, a recognised qualification for people working in the care profession. The manager confirmed that it is expected that new staff members will enrol on an NVQ and that the relatively low percentage of staff with the qualification at the time of our visit had been caused by the staffing issues outlined above. We looked at three staff files and found that they did not contain all of the information required. We found that gaps in employment were not being checked and a number of references did not indicate what relationship the person had with the prospective employee. We believe that improvements need to be made in order to fully protect the people who live at Wrenbury from harm and possible poor practice. New staff members confirmed that they had an induction when they had started work at the home. This included shadow shifts, working as a supernumerary for approximately two weeks and that they had had safety routines, such as fire safety explained to them. None of the staff members we spoke to said that they had completed a formal induction record which is a requirement for the home to complete. Wrenbury provides a range of training courses for staff members; recent courses include moving and handling and adult protection. The staff members we spoke to confirmed that they had undertaken these and the records we looked at confirmed this. We did however find that there were gaps in training and some mandatory training such as fire safety was overdue for a number of people. We feel that training in general needs to be improved in order to ensure that all of the staff members employed at the home provide safe care, in line with current guidelines. 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. The home is well-managed to ensure that people are kept safe. Evidence: The home manager has been in post for eleven years and has shown great commitment to the service. She has continued to develop her own knowledge and skills and has gained qualifications relating to health and safety, and teaching and assessing. The home owner visits regularly and the staff we spoke with all knew the home owner. Regular staff meetings are held and the home owner attends some of these meetings. The most recent meeting took place on 25 February 2010. The staff members we spoke to confirmed that this had taken place. The home has a quality and assurance system in place and questionnaires have recently been completed by family members. These are generally positive and comments included, Communication is always of a high standard and we feel that our Care Homes for Older People Page 21 of 26 Evidence: relative is well cared for 24 hours a day. We observed that relatives have good relationships with the manager. The manager does not hold resident or relative meetings but said that she regularly gets the views of residents and relatives informally on a one to one basis. Whilst looking at a sample of the quality assurance questionnaires we did find some comments that would suggest that some people would like a meeting to be held; comments included, meetings would be useful. We discussed this during the feedback meeting that took place at the end of the inspection. We suggested that they may be of more benefit if the meeting was arranged to discuss a particular topic, for example, food or the laundry. The owner and manager agreed that they would look into doing this. The home does not look after the finances of any residents but small amounts of personal spending money can be put in safekeeping and full records are kept. Information provided by the manager indicated that all plant and equipment are regularly checked, serviced and maintained. One of the the two maintenance people and the home manager have completed a health and safety course. Policies and procedures are in the process of being reviewed and updated. Care Homes for Older People Page 22 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 23 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 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 29 19 Appropriate recruitment checks must be undertaken when appointing new staff members. This is to make sure that staff are suitable to work with the people who live at the home and so residents are protected. 31/03/2010 2 30 18 Appropriate training must be 31/03/2010 provided to all of the staff members working in the home. This is to make sure that residents are supported by well trained and competent staff members. 3 30 18 New staff members must receive a structured induction when they start working at the home. 31/03/2010 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 This is so staff members are trained correctly when they first start working at the home. 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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