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Charges do not include items such )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 715.47 Tm (as newspapers, toiletries, taxis etc.)Tj ET /F2 12 Tf BT 1 0 0 1 33.25 698.47 Tm ()Tj ET endstream endobj 18 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 19 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Subtype/Form/FormType 1/Matrix[1 0 0 1 0 0]>>stream xn1 9eI J qU5ea<>vfTZߍ=s?X)9(\"j_]<7^~[-xώd\bft=|.)j(QE hHI"ͷz`5%x:z^jQ _׃:^Q؂,hnCŰ+J[ uD&,vG}!Ej+Klql=s|b `srDs 9EVՌ%rtu;:mZ4:݅6!TlYU3QPN]#];p֒]\6ٻ(9G%VՄCݏɋI\^ܝn-j:ק݁.nu"׾7;;6 ތëi:Oj,ޚ2 UN%/W9{G.3…5\x8`G-zB1L8@~~9M {QѣH i{ZKP,c3oWny~qf endstream endobj 20 0 obj<> endobj 21 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (6)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 14 Tf BT 1 0 0 1 28.35 795.65 Tm (6XPPDU\\)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 774.7 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.22 m 381.05 754.22 l S 0.001 w 1 1 1 RG 20.58 w 383.3 754.22 m 566.2 754.22 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 765.64 m 568.4 765.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 742.81 m 568.4 742.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 766.71 m 30.07 741.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 382.17 766.71 m 382.17 741.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 766.71 m 567.32 741.73 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 749.45 Tm (The quality rating for this )Tj ET /F2 12 Tf BT 1 0 0 1 191.92 749.45 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 255.59 749.45 Tm ( is:)Tj ET /F2 12 Tf BT 1 0 0 1 410.5 749.45 Tm (zero star poor service)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 717.31 Tm (2XUMXGJHPHQWIRUHDFKRXWFRPH)Tj ET /F2 10 Tf BT 1 0 0 1 212.29 641.27 Tm (Choice of home)Tj ET /F2 10 Tf BT 1 0 0 1 164.41 601.02 Tm (Health and personal care)Tj ET /F2 10 Tf BT 1 0 0 1 145.18 560.77 Tm (Daily life and social activities)Tj ET /F2 10 Tf BT 1 0 0 1 157.95 520.52 Tm (Complaints and protection)Tj ET /F2 10 Tf BT 1 0 0 1 226.36 480.27 Tm (Environment)Tj ET /F2 10 Tf BT 1 0 0 1 251.17 440.02 Tm (Staffing)Tj ET /F2 10 Tf BT 1 0 0 1 127.47 399.77 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75161 305.05 334.32 cm /Xf1 Do Q 1 1 1 RG 20.58 w 31.2 283.08 m 567.85 283.08 l S 0.001 w 206.51 w 32.32 167.28 m 566.72 167.28 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.2 271.66 m 567.85 271.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 271.66 m 568.92 271.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 62.9 m 568.92 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 272.74 m 31.2 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 272.74 m 567.85 61.82 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 278.3 Tm (How we did our inspection:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 35.17 255.48 Tm (This unannounced key inspection was due to be undertaken in November 2009. It was )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 240.9 Tm (bought forward as we had received some concerns about the quality of care that )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 226.32 Tm (people living here are receiving.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 211.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 197.15 Tm (During this visit we \(the commission\) spoke with or observed the majority of people )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 182.57 Tm (living here. We could not speak with some people because they have communication )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 167.99 Tm (difficulties such as dementia. We looked closely at the care, services and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 153.41 Tm (accommodation offered to four people living here. This is called case tracking and helps )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 138.84 Tm (us to make a judgment about the standard of care overall, and helps us to understand )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 124.25 Tm (the experiences of people who live here.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 109.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 95.1 Tm (We looked at the care and attention given by staff to these people and we looked at )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 80.51 Tm (their assessments and at their care planning records. We looked at the environment in )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 65.93 Tm (relation to their needs and how their health and personal care needs are met. We also )Tj ET endstream endobj 22 0 obj<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 23 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (7)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 280.02 w 32.32 672.52 m 566.72 672.52 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 30.12 813.65 m 568.92 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 531.38 m 568.92 531.38 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 814.73 m 31.2 530.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 814.73 m 567.85 530.31 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 32.92 802.72 Tm (spoke with visitors to the home, with staff and with the manager and one of the )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 788.14 Tm (owners. We visited the majority of bedrooms and saw all service and communal areas )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 773.56 Tm (of the home.)Tj ET /F2 12 Tf BT 1 0 0 1 32.92 758.98 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 744.4 Tm (We looked at records relating to accidents and incidents, staff training, staff )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 729.82 Tm (recruitment, medication and at some policies.)Tj ET /F2 12 Tf BT 1 0 0 1 32.92 715.24 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 700.66 Tm (Prior to the inspection the owners sent us their Annual Quality Assurance Assessment )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 686.08 Tm (\(AQAA\) which gave us information about the home and it's management and about the )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 671.5 Tm (needs of people living here. This document asks for evidence in relation to what the )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 656.92 Tm (home does well and what they think they can improve upon.)Tj ET /F2 12 Tf BT 1 0 0 1 32.92 642.34 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 627.76 Tm (In addition, we sent surveys to 8 people living here and 3 were returned. We sent 8 )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 613.18 Tm (surveys to staff and 3 were returned. We sent 4 surveys to health and social care )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 598.6 Tm (professionals and all were returned. Feedback and comments are included in the )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 584.02 Tm (report.)Tj ET /F2 12 Tf BT 1 0 0 1 32.92 569.44 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 554.86 Tm (During this inspection evidence was taken under the Police and Criminal Evidence Act )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 540.28 Tm (and this has been considered under our enforcement procedures.)Tj ET endstream endobj 24 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 25 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (8)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 20.58 w 31.2 786.36 m 567.85 786.36 l S 0.001 w 64.32 w 32.32 741.66 m 566.72 741.66 l S 0.001 w 20.58 w 32.7 696.96 m 569.35 696.96 l S 0.001 w 93.48 w 33.82 637.68 m 568.22 637.68 l S 0.001 w 20.58 w 33.45 578.4 m 570.1 578.4 l S 0.001 w 501.84 w 34.57 314.95 m 568.97 314.95 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.2 774.95 m 567.85 774.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 774.95 m 568.92 774.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 708.38 m 568.92 708.38 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 776.03 m 31.2 707.3 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 708.38 m 569.35 708.38 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.7 685.55 m 569.35 685.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.62 685.55 m 570.42 685.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.62 589.82 m 570.42 589.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 566.99 m 570.1 566.99 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 589.82 m 570.1 589.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.37 566.99 m 571.17 566.99 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.37 62.9 m 571.17 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.7 686.63 m 32.7 588.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 568.07 m 33.45 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 776.03 m 567.85 707.3 l S 0.001 w [] 0 d [] 0 d 2.25 w 569.35 686.63 m 569.35 588.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 570.1 568.07 m 570.1 61.82 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 781.59 Tm (What the )Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 90.52 781.59 Tm (care home)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 154.2 781.59 Tm ( does well:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 567.85 784.25 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 758.76 Tm (This home is warm, clean and comfortable. Staff are described as nice and caring and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 744.18 Tm (as doing their best. The home has a lot of nursing equipment such as adjustable beds )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 729.6 Tm (and pressure relieving mattresses. People really enjoy the food served here which is )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 715.02 Tm (nutritious and offers variety. )Tj ET /F2 10 Tf BT 1 0 0 1 568.97 740.11 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 694.85 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 32.7 692.19 Tm (What has improved since the last inspection?)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 569.35 695.41 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 636.13 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 669.36 Tm (Since the last inspection the programme of redecoration has continued. We saw that a )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 654.78 Tm (window was being replaced and that the front door is now secured with a key pad type )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 640.2 Tm (lock.)Tj ET /F2 12 Tf BT 1 0 0 1 36.67 625.62 Tm (The home has employed a part time activities co-ordinator and this person's efforts are )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 611.04 Tm (having an impact for some people.)Tj ET /F2 12 Tf BT 1 0 0 1 36.67 596.46 Tm (The Requirement made at the last inspection in relation to medicines has been met. )Tj ET /F2 10 Tf BT 1 0 0 1 570.47 636.13 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 576.85 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 33.45 573.63 Tm (What they could do better:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 31.2 313.39 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 550.8 Tm (This home does not have a registered manager and is not being sufficiently well )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 536.22 Tm (managed. This has resulted in people's health and welfare needs not always being )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 521.64 Tm (assessed or met. The care planning and communicating systems in place are not )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 507.06 Tm (sufficiently robust to ensure that care staff have the information they need about )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 492.48 Tm (people's care needs and how these should be met.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 477.9 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 463.32 Tm (Staff are well intentioned but are not always on duty in sufficient numbers, and do not )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 448.74 Tm (always have the support they need, to meet people's needs. On one night there was )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 434.16 Tm (not a waking Registered Nurse on duty. Staff are not recruited in a robust way and this )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 419.58 Tm (means that people are at risk of being cared for by inappropriate staff.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 405 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 390.42 Tm (People are not always treated with dignity and their rights to make choices or to be )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 375.84 Tm (engaged and sociable are not always supported. Some people's sense of self and )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 361.26 Tm (personal identity is in danger of being eroded by a system that is not always person )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 346.68 Tm (centred and is sometimes institutionalised.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 332.1 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 317.52 Tm (Complaints have been made to the commission by some people. They complain that )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 302.94 Tm (the home is not well managed and the quality of care has declined. These concerns are )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 288.36 Tm (being investigated by the local safeguarding team. This is the second safeguarding )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 273.78 Tm (alert that has been made since the last inspection. Whilst this investigation is ongoing, )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 259.2 Tm (admissions to this home via health or social care services have been suspended by )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 244.62 Tm (Adult and Community Services.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 230.04 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 215.46 Tm (Staff training is not up to date and some specialist training is being designated to )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 200.88 Tm (people who are not qualified or experienced to carry this out.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 186.3 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 171.72 Tm (Some working practices and systems are not ensuring people's safety. This includes )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 157.14 Tm (moving and handling people, ensuring windows are restricted to prevent accidental )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 142.56 Tm (falls, the maintenance of equipment and risk assessments and actions in relation to the )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 127.98 Tm (use of restraint. Systems are not robust enough to ensure that it is clear which staff )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 113.4 Tm (have received mandatory training and which have not. The system for recording and )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 98.82 Tm (monitoring accidents and incidents is not being used to help prevent further accidents.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 84.24 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 69.66 Tm (The commission have not been kept informed in relation to all incidents, accidents and )Tj ET endstream endobj 26 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 27 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (9)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 148.8 w 34.57 738.13 m 568.97 738.13 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 32.37 813.65 m 571.17 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.37 662.6 m 571.17 662.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 814.73 m 33.45 661.53 l S 0.001 w [] 0 d [] 0 d 2.25 w 570.1 814.73 m 570.1 661.53 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.17 802.72 Tm (deaths in the home, as we should be so that we can monitor this type of activity in the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 788.14 Tm (home.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 773.56 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 758.98 Tm (Statutory Requirement Notices have been issued to the registered owners of this )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 744.4 Tm (service. These Notices inform the providers that they have failed to comply with the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 729.82 Tm (Care Home Regulations 2001 in relation to planning people's care and in relation to )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 715.24 Tm (meeting people's health and welfare needs. The Statutory Requirement Notices tell the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 700.66 Tm (providers what they must do and gives them dates by when the failures identified must )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 686.08 Tm (be addressed.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 671.5 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 648.04 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 628.05 Tm (If you want to know what action the person responsible for this )Tj ET /F2 12 Tf BT 1 0 0 1 416.37 628.05 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 480.04 628.05 Tm ( is taking )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 610.55 Tm (following this report, you can contact them using the details on page 4.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 590.56 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 570.56 Tm (The report of this inspection is available from our website )Tj ET /F2 12 Tf BT 1 0 0 1 380.85 570.56 Tm (www.cqc.org.uk.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 550.56 Tm (You can get printed copies from )Tj ET /F2 12 Tf BT 1 0 0 1 225.22 550.56 Tm (enquiries@cqc.org.uk or by telephoning our)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 530.57 Tm (order line 0870 240 7535.)Tj ET endstream endobj 28 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 29 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (10)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 777.09 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 26 w 31.2 744.15 m 565.9 744.15 l S 0.001 w /F1 12 Tf BT 1 0 0 1 34.05 741.14 Tm (&RQWHQWV)Tj ET 1 1 1 RG 16 w 28.35 700.15 m 566.93 700.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 696.09 Tm (Choice of home \(standards 1 - 6\))Tj ET 16 w 28.35 678.15 m 566.93 678.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 674.09 Tm (Health and personal care \(standards 7 - 11\))Tj ET 16 w 28.35 656.15 m 566.93 656.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 652.09 Tm (Daily life and social activities \(standards 12 - 15\))Tj ET 16 w 28.35 634.15 m 566.93 634.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 630.09 Tm (Complaints and protection \(standards 16 - 18\))Tj ET 16 w 28.35 612.15 m 566.93 612.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 608.09 Tm (Environment \(standards 19 - 26\))Tj ET 16 w 28.35 590.15 m 566.93 590.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 586.09 Tm (Staffing \(standards 27 - 30\))Tj ET 16 w 28.35 568.15 m 566.93 568.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 564.09 Tm (Management and administration \(standards 31 - 38\))Tj ET /F2 12 Tf BT 1 0 0 1 28.35 544.09 Tm (Outstanding statutory requirements)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 522.22 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 30 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 31 0 obj<> endobj 32 0 obj<> endobj 33 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (11)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Choice of home )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 206.25 w 32.32 610.38 m 562.53 610.38 l S 0.001 w 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.65 672.13 l S 0.001 w 1 1 1 RG 119 w 31.2 567.88 m 563.65 567.88 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 507.25 m 565.85 507.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 506.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 506.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 Tm (People are confident that the care home can support them. This is because there is an )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 685.57 Tm (accurate assessment of their needs that they, or people close to them, have been )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.57 Tm (involved in. This tells the home all about them and the support they need. People who )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.57 Tm (stay at the home only for intermediate care, have a clear assessment that includes a )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.57 Tm (plan on what they hope for and want to achieve when they return home.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 615.32 Tm (People can decide whether the care home can meet their support and accommodation )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 598.32 Tm (needs. This is because they, or people close to them, have been able to visit the home )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 581.32 Tm (and have got full, clear, accurate and up to date information about the home. If they )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 564.32 Tm (decide to stay in the home they know about their rights and responsibilities because )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 547.32 Tm (there is an easy to understand contract or statement of terms and conditions between )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 530.32 Tm (them and the care home that includes how much they will pay and what the home )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 513.32 Tm (provides for the money.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 489 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 467 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 467 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 444.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 141.85 w 34.6 369.25 m 562.54 369.25 l S 0.001 w 1 1 1 RG 22.5 w 32.35 431.17 m 564.79 431.17 l S 0.001 w 119.35 w 33.47 358 m 563.66 358 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 418.8 m 565.87 418.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 419.88 m 32.35 296.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 419.88 m 564.79 296.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 418.8 m 564.79 418.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 297.2 m 565.87 297.2 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 427.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 403.12 Tm (poor)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 290.57 403.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 358.75 Tm (Some people move into this home without having their needs fully assessed and )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 341.25 Tm (without agreement from the funding authority. This means that people cannot be sure )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 323.76 Tm (that their needs will be met in an appropriate way or that they will be staying in this )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 306.26 Tm (home. )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 281.52 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 189.3 w 34.6 176.68 m 562.54 176.68 l S 0.001 w 1 1 1 RG 22.5 w 32.35 262.33 m 564.79 262.33 l S 0.001 w 167.93 w 33.47 164.87 m 563.66 164.87 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 249.96 m 565.87 249.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 251.04 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 251.04 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 249.96 m 564.79 249.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 259.02 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 234.27 Tm (In surveys two out of three people who live here told us that they had the information )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 216.78 Tm (they needed to decide if this was the home for them. In addition, two out of three )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 199.28 Tm (health care professionals say that the home's assessment arrangements usually )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 181.79 Tm (ensure that accurate information is gathered and that the right service is planned for )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 164.29 Tm (people. One health care professional told us that this always happens.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 146.79 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 129.3 Tm (We were told that the home had admitted two people to this home without an )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 111.8 Tm (assessment by and without the agreement of the funding authority. When we looked )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 94.31 Tm (at records we found these people had been admitted from a residential home owned )Tj ET endstream endobj 34 0 obj<> endobj 35 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 36 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (12)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 336.3 w 34.6 643.26 m 562.54 643.26 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 314.93 w 33.47 631.44 m 563.66 631.44 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 471.78 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 471.78 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 472.86 m 565.87 472.86 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (by the owners of this home.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (We spoke with staff who told us that one of these people had moved here because )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (they have nursing needs and therefore need their care to be planned and delivered by )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (registered nurses.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (We looked at the records of one of these people. We found that an assessment of their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (nursing needs had not taken place prior to their admission, or since their admission. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (We found that all assessments in their records have been carried out in the home they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (used to live in.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (We could not speak with this person about their feelings about the move as they have )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (communication difficulties. We spoke with the relative of another person living here. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (They told us that they had looked around the home and at the bedroom the person )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (would move into. They were able to ask questions about the home before deciding this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (was the right home. However, we noted that this person's care record did not contain )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (pre admission information from health and social care professionals as it should.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm ()Tj ET endstream endobj 37 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 38 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (13)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Health and personal care )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 172.25 w 32.32 627.38 m 562.53 627.38 l S 0.001 w 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.65 663.63 l S 0.001 w 1 1 1 RG 68 w 31.2 576.38 m 563.65 576.38 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 611.5 m 565.85 611.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 611.5 m 565.85 611.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 541.25 m 565.85 541.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 540.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 540.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 Tm (Peoples health, personal and social care needs are met. The home has a plan of care )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 685.57 Tm (that the person, or someone close to them, has been involved in making. If they take )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.57 Tm (medicine, they manage it themselves if they can. If they cannot manage their )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.57 Tm (medicine, the care home supports them with it, in a safe way. Peoples right to privacy )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.57 Tm (is respected and the support they get from staff is given in a way that maintains their )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 617.57 Tm (dignity.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 598.32 Tm (If people are approaching the end of their life, the care home will respect their choices )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 581.32 Tm (and help them feel comfortable and secure. They, and people close to them, are )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 564.32 Tm (reassured that their death will be handled with sensitivity, dignity and respect, and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 547.32 Tm (take account of their spiritual and cultural wishes. )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 523 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 501 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 501 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 478.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 141.85 w 34.6 403.25 m 562.54 403.25 l S 0.001 w 1 1 1 RG 22.5 w 32.35 465.17 m 564.79 465.17 l S 0.001 w 119.35 w 33.47 392 m 563.66 392 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 452.8 m 565.87 452.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 453.88 m 32.35 330.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 453.88 m 564.79 330.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 452.8 m 564.79 452.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 331.2 m 565.87 331.2 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 461.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 437.12 Tm (poor)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 290.57 437.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 392.75 Tm (Peoples' medicines are safely managed. However, some people are being put at risk )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 375.25 Tm (because their health and welfare needs are not being met. People do not have their )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 357.76 Tm (care planned in a person centred way that treats them as individuals and are not )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 340.26 Tm (always treated with dignity. )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 315.52 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 223.3 w 34.6 193.68 m 562.54 193.68 l S 0.001 w 1 1 1 RG 22.5 w 32.35 296.33 m 564.79 296.33 l S 0.001 w 201.93 w 33.47 181.87 m 563.66 181.87 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 283.96 m 565.87 283.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 285.04 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 285.04 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 283.96 m 564.79 283.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 293.02 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 268.27 Tm (In surveys people living here told us they usually get the care and support they need )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 250.78 Tm (and that they always or usually get the medical support they need.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 233.28 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 215.79 Tm (Two health care professionals told us that people's health care needs are always )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 198.29 Tm (properly monitored and one told us this usually happens. Two also said that the staff )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 180.79 Tm (at the home seek advice and act on it to improve well being, and one said that this )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 163.3 Tm (sometimes happened. Comments from health care professionals include that staff act )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 145.8 Tm (promptly to get medical help for people who need it and that some people have )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 128.31 Tm (blossomed since living here.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 110.81 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 93.31 Tm (We looked in depth at the care plans of four people living here. We also looked at )Tj ET endstream endobj 39 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 40 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (14)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (some others. We found that each person has a plan of care and that these contain a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (large number and range of documents relating to care needs. However, these )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (documents were not person centred, are sometimes contradictory and do not always )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (provide care staff with the detailed information that they need to meet people's needs.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (For example one person that we case tracked has been admitted from the owners' )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (residential home. This person's care plan is the care plan from that home. Staff told us )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (that the reason this person was admitted to this home was because staff believe that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (they need the 24 hour care of nurses. However, nurses have not devised a care plan )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (as to how this person's nursing needs are to be met. In addition, information recorded )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (in the daily notes from the residential home has not been followed up. Before being )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (admitted to this home, it was recorded that this person has a urinary catheter, is )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (prone to urinary tract infections and needs encouragement to drink. Two days before )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (being admitted it is recorded that this person had very strong and dark urine which )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (means this person may not be drinking enough fluid. This person has lived in this care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (home for approximately 6 weeks and the care notes have not mentioned this person's )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (urine. We asked staff about this and they told us that the night staff empty the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (catheter bag and that they didn't know how much urine this person passed or what )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (colour it is.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (We looked to see how much this person drinks in a day because the residential care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (home instructions state that they should be encouraged to drink to prevent urinary )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (tract infections. We saw records that show this person drinks between 200mls and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (1050mls in a day. The records do not contain instructions about how much this person )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (should drink in a day. We asked carers how much this person should drink to keep )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (them healthy and they thought that this would be about 1000mls. We asked carers if )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (they knew how much this person had drunk in the past days and they said they did )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (not because the nurse totals up the amount drunk. A nurse has reviewed the records )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (kept about this person and the amount they have drunk. They record, in different )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (places in the care plan, that they have drunk a fair amount, small amount and a good )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (amount. However, these reviews do not appear to have taken into account the days )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (when this person has only drunk 200mls, 350mls and 400mls. We have calculated )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (that this person, according to their weight, should have at least 1880mls to drink each )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (day. We spoke with the temporary manager about how much people should drink. She )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (told us she knows there is a calculation to work this out, but does not know what it is. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (We also noted that records show that this person does not have a drink between 6pm )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (and 8 or 9am. This is a very long time for someone who has a catheter and is prone to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (urinary tract infections.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (We observed this person on the day of this inspection. They had numerous drinks put )Tj ET endstream endobj 41 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 42 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (15)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (in front of them by members of staff. No encouragement to drink was given by staff, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (but was given by their wife. we would estimate that this person drank approximately )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (50mls between 10am and 1pm.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (We also saw that other people do not have enough to drink.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (We saw in care plans that people are assessed to see if they are at risk of developing )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (pressure sores. We saw that people we had case tracked are at risk. These people are )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (cared for on pressure relieving mattresses and cushions as is good practice. Some )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (people are also nursed on adjustable beds which is also good practice. We were told )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (that one person has developed a pressure sore since coming to live here and that one )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (person came to the home having already developed a pressure sore. We looked at )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (some pressure relieving equipment. We found one mattress had been set to the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (maximum pressure indicating that the person using this mattress is heavy. When we )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (looked in care records we found that this person is very light. We asked staff how they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (work out the pressure that the mattress should be set to. One person said they did )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (not know, another said the person setting it up does it. We looked in care plans, in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (people's bedrooms and on the mattress motors to see if staff have access to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (instructions about the pressure each mattress should be set at. We did not find any )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (instructions.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (We saw in care plans that some people are at risk of malnutrition. One person we case )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (tracked is losing weight. The GP has been informed. However, the recommendations )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (made by the specialist nutritional tool used \(MUST\) have not been followed. According )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (to this person's level of risk they should be having specific drinks to supplement their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (calorie intake. Records show that these are given intermittently and not routinely. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (asked staff if this person has supplement drinks and they said no.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (We noted in another person's records that they had been having loose bowel motions )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (and saw and heard from a relative that they had been off their food. Records also )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (show that this person has been what is described as 'grumpy'. This person has been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (weighed weekly. Although the most recent weight shows a weight gain, the general )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (trend is that this person is losing weight. There was no record to show that this is )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (being addressed. Staff are not keeping records of what this person eats and drinks. A )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (nurse had recorded that they had reviewed this care plan but had not taken any action )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (to address these health issues. This means that this person's health is not being )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (monitored appropriately and might result in a delay in appropriate action being taken.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (Prior to this inspection, the owners provided us with an updated improvement plan in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (relation to requirements made at the last inspection about meeting people's nutritional )Tj ET endstream endobj 43 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 44 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (16)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (needs. This told us that the completion of the nutritional risk assessment tool \(MUST\) )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (and for taking action if risk is identified has been designated to the catering manager. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (This person, along with other staff in the home, has received training in relation to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (nutrition from a company that supplies nutritional supplements. However, this does )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (not qualify them to carry out these assessments or to determine the actions that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (should be taken.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (Another care plan recorded that one person stays in bed all day and does not get )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (dressed. It states the reason for this as them being immobile and having contractures )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (of their legs. Records do not include evidence that consideration has been given, or )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (that actions have been taken, to make arrangements or find moving and handling )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (equipment that might allow this person to move out of their bed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (We looked at other records relating to people with dementia. Care plans state for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (example, that some people have a poor mental state and reduced powers of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (comprehension. However, care plans do not provide a plan as to how these people's )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (mental health and welfare needs are to be addressed or met. In addition, it has been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (agreed on three people's behalf, who are described as confused or having dementia, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (that they would like to get them up as early as 6am. One of these people has an )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (illness the symptoms of which include stiffness, especially in the morning and fatigue. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (These symptoms do not seem to have been considered in the decision to get them up )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (early.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (We observed that one person is at high risk of choking as they have difficulty )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (swallowing. This person was referred to the Speech and Language Therapist \(SALT\) )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (some time ago. However, a visiting health care professional observed that staff were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (not following the guidance given by the SALT. They asked this specialist to visit again. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (Instructions were left for staff to follow as to how this person is to be supported to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (eat. We saw that some of this guidance is being put into practice. However, we also )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (saw that some is not. For example, we saw that nurses saw a visitor offering this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (person a chocolate covered wafer. They did not explain to the visitor that this might )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (cause problems for this person's swallowing. We saw this person in their wheelchair, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (leaning over to one side after lunch. This person is meant to sit up for 30 mins after )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (eating. We saw that a member of staff put this person to bed soon after lunch, lying )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (down. We asked staff about how this person is supported to eat and not choke. They )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (told us what they knew, but did not know that this person should be sat up for 30mins )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (after they had eaten. Staff told us this person has a pureed diet which complies with )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (the SALT instructions. They also told us that they give this person cake and biscuits, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (which puts this person at risk of choking. The care plan does not contain instructions )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (for staff about what to do if this person chokes. One carer told us they would use their )Tj ET endstream endobj 45 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 46 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (17)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (common sense and try a grab and thrust movement. A nurse told us she hoped that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (staff would know to call a nurse or 999. This lack of instruction means that there may )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (be a delay in this person getting appropriate help.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (We asked the manager how staff have been given information about this person's )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (needs and risk of choking since the most recent visit by the SALT. We were told that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (the nurses had been told about the special requirements for this person, and the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (nurses were named, and that they give this information to the carers. We saw from )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (the duty rota that one of these nurses had been on sick leave over this period. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (manager confirmed this adding that the nurses already knew about the advice. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (reminded her that the SALT referral was made again because staff were not following )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (the advice given, and this was putting this person at risk of choking.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (We saw in the improvement plan provided by the owners that staff have had training )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (from the SALT in supporting people who have difficulties swallowing. This document )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (also tells us that further updates will be given by the catering manager. This person is )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (not qualified to do this and this is not good practice. We have checked with the SALT )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (and they have told us that they are happy to provide further training if needed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (We saw that many people living here have mobility problems. We checked care plans )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (to see if people had had their moving and handling needs assessed. We found that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (some people had not had these needs assessed. We found another that was dated )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (April 2007 which had not been reviewed or updated since that time. Care plans give )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (very general instructions for care staff such as 'needs hoist'. They did not specify the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (type of hoist to be used or the size of sling. We spoke to a nurse about how staff know )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (which hoist and sling to use. The nurse told us that if a person is on the ground floor )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (they use the hoist that is on that floor and that carers make a judgment about what )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (size sling to use. This means that carers are not being supported to ensure that they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (use the appropriate equipment for each person.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (We also noted that the hoist is often used to help people who have been incontinent of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (urine. We saw that people share slings which does not help to prevent the spread of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (infection and indicates that care is de-personalised.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (Care plans in this home are in two parts. There is a larger comprehensive part which )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (contains details relating to the person and the plan of care. There is also a day to day )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (record which the manager told us is what carers use. Instructions in these smaller )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (records contain task orientated information such as needs feeding, hoist, weekly )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (weight and on fluid chart. These are not person centred and do not give care staff the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (information they need to provide individualised care based on each person's individual )Tj ET endstream endobj 47 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 48 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (18)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (needs and preferences.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (Carers told us they do not tend to read care plans, although they do write in them. For )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (example they record fluid and food intake if people need to have this recorded. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (found that entries made by staff include impersonal comments such as pad changed, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (repositioned, soaking wet bed, usual day and nothing new. This type of language is an )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (indicator that the provision of care is task orientated and de personalised.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (We asked how staff get the information they need about people and their needs if they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (do not read care plans. They told us they know people, or get to know them. They say )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (they do not get a handover of information when they come on duty, that only the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (nurse gets this. They say they start work straight away. They know who needs getting )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (up and who needs breakfast. We asked the temporary manager how it is ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (carers have the information they need to care for people and were told that she would )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (hope nurses give this. This means there is not a robust system in place to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (care staff have the information and guidance they need to ensure that people's needs )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (are met.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (We saw that care plans are reviewed by nurses. However, we noted that despite )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (changes in people's conditions that there were no changes to the plans of care. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (also noted that reviews of care plans do not record what information has been used to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (make the nursing decisions.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (The pharmacist inspector inspected the way that medicines are managed in this home. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (We looked at arrangements for storing and giving medicines in the home. We checked )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (the records that are held in the home for medicines given to people, and discussed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (how medicines are handled with the manager and other staff working in the home. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (were told that sometimes people can look after and take their own medicines. There )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (are not any people living in the home at the moment who do this, and people are )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (given their medicines by nursing staff.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (Medicines are stored safely for the protection of people in the home. There are )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (suitable arrangements for controlled drugs and any medicines requiring cold-storage.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (Records are kept of medicines received into the home, and of any unwanted medicines )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (that are sent for destruction. Records are kept of medicines that are given to people, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (which helps to show that people receive their medicines as prescribed by the doctor. If )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (a regularly prescribed dose is omitted, then a reason for this is recorded, as is good )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (practice. Usually if a variable dose is prescribed there are clear records to show how )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (much is given, and this too is good practice.)Tj ET endstream endobj 49 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 50 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 686.22 w 34.6 468.3 m 562.54 468.3 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 664.85 w 33.47 456.48 m 563.66 456.48 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 121.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 121.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 122.93 m 565.87 122.93 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (We looked at some people's care plans to see what information is recorded about their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (medicines. We found written permission from the doctor to crush someone's tablets )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (before giving. Staff had not asked if other forms of the same medicines are available, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (such as soluble tablets or liquids, to make it easier for people to take. We found clear )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (guidance for staff on when to administer medication that was prescribed to be given )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm ('when required'. This helps to show that people receive their medicines in the way )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (their doctor intended for them.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (We looked at how people's privacy and dignity is maintained. We heard people being )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (called by their preferred names and some people were able to tell us they wear their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (own clothes. We saw staff discreetly helping some people go to the toilet. However, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (we also saw one person trying to attract the attention of staff who walked past or said )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm ('hang on' as they walked past and did not come back. We heard one person saying no )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (repeatedly and we heard a carer saying 'yes, yes, yes' in a mocking fashion.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (We saw in the care plans of two people that they like to be or are washed, shaved, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (have their hair brushed and dressed whilst sitting on the commode. This is not a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (dignified way to provide care. In addition a record of names of people who had taken )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (a bath is kept in the communal bathroom. This indicates an institutional approach to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (people's personal care needs and to their confidentiality.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (We saw one person being hoisted to be taken to the toilet. When raised out of their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (seat there was a strong smell of urine. After they left the lounge, the smell persisted. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (We smelt the chair and found that the smell was coming from the fabric of the chair, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (and from the pressure relieving cushion on the chair. When staff returned they put )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (this person back onto the chair. Each time this person shifted their weight in their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (chair, there was an unpleasant odour of stale urine released.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (We saw that two people share a bedroom. There are no records to show that each )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (person has been consulted or made an informed choice about this, as should happen. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (We saw that the room can be divided by a curtain. When we asked one person if this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (was used, they told us that it isn't always. Although this person says they don't mind, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (it is unclear what the other person sharing this room thinks or feels about this as they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (have communication difficulties.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (One health care professional commented that sometimes shared rooms create )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (problems around privacy and dignity. )Tj ET endstream endobj 51 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 52 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (20)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Daily life and social activities )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 138.25 w 32.32 644.38 m 562.53 644.38 l S 0.001 w 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.65 655.13 l S 0.001 w 1 1 1 RG 17 w 31.2 584.88 m 563.65 584.88 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 594.5 m 565.85 594.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 594.5 m 565.85 594.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 575.25 m 565.85 575.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 574.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 574.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 Tm (Each person is treated as an individual and the care home is responsive to his or her )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 685.57 Tm (race, culture, religion, age, disability, gender and sexual orientation. They are part of )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.57 Tm (their local community. The care home supports people to follow personal interests and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.57 Tm (activities. People are able to keep in touch with family, friends and representatives. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.57 Tm (They are as independent as they can be, lead their chosen lifestyle and have the )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 617.57 Tm (opportunity to make the most of their abilities. People have nutritious and attractive )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 600.57 Tm (meals and snacks, at a time and place to suit them.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 581.32 Tm (There are no additional outcomes.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 557 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 535 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 535 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 512.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 141.85 w 34.6 437.25 m 562.54 437.25 l S 0.001 w 1 1 1 RG 22.5 w 32.35 499.17 m 564.79 499.17 l S 0.001 w 119.35 w 33.47 426 m 563.66 426 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 486.8 m 565.87 486.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 487.88 m 32.35 364.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 487.88 m 564.79 364.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 486.8 m 564.79 486.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 365.2 m 565.87 365.2 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 495.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 471.12 Tm (adequate)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 319.4 471.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 426.75 Tm (Some people's quality of life is enhanced by continued links with their families and )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 409.25 Tm (friends and by the activities they take part in. However, not everyone is having their )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 391.76 Tm (individual social needs and rights to make choices met.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 374.26 Tm (People enjoy an appetising, balanced diet that meets their nutritional needs.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 349.52 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 257.3 w 34.6 210.68 m 562.54 210.68 l S 0.001 w 1 1 1 RG 22.5 w 32.35 330.33 m 564.79 330.33 l S 0.001 w 235.93 w 33.47 198.87 m 563.66 198.87 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 317.96 m 565.87 317.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 319.04 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 319.04 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 317.96 m 564.79 317.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 327.02 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 302.27 Tm (Since the last inspection the home has employed an activities co-ordinator for 20 )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 284.78 Tm (hours each week. This person is responsible for meeting the social needs of all the )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 267.28 Tm (people living here and provides support with helping people to eat and with personal )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 249.79 Tm (care such as cutting people's nails.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 232.29 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 214.79 Tm (In surveys people told us there are usually activities they can take part in if they want )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 197.3 Tm (to. We saw that about 4 people who spend their time in the lounge are well attended )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 179.8 Tm (to. We saw people took part in a picture quiz, in card games and in physical activity. )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 162.31 Tm (These people were having fun, were being included, were relaxed and were treated )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 144.81 Tm (with respect and with warmth. We saw that one person in particular is really )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 127.31 Tm (benefiting from having this social interaction.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 109.82 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 92.32 Tm (We also saw the the lounge is laid out in such a way that separate areas have been )Tj ET endstream endobj 53 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 54 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (21)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (created. This means that people can take part in different activities or have )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (conversations without disturbing anyone else, and away from the television. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (television was on throughout the day during this inspection. It was set to a very high )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (volume and no one was watching it. One person did take an interest when the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (lunchtime news came on. They told us they like to hear the news, but that they're not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (bothered otherwise.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (We saw one person enjoying knitting who also benefited from the activities organised. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (Other people were invited to join in and declined or were unable to do so due to their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (disabilities.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (Other people living in this home spend time in their rooms. We spoke with staff about )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (how these people are supported to have their social needs met. We were told the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (activities co-ordinator spends time with these people in their rooms. We found that, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (whilst well intentioned and very skillful, this person cannot meet the social needs of all )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (the people living here. People who are physically or mentally disabled spend long )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (periods alone.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (One person told us they get bored lying in bed all day. Their relative said that staff )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (come into the room, but that this is to carry out care tasks such as turning. The care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (plan for this person does not contain any information about their interests or religious )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (or spiritual needs.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (Other care plans contain some information about people's interests. However, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (knowledge about these interests is not being used to meet each person's need to be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (engaged and be social in an individualised way.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (For example each care plan has sections about people's spiritual needs. The care plan )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (of one person who has dementia states they are very religious and identifies their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (religion. The care plan section relating to social needs records that this person loves to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (go out. The care plan does not identify how this person will be supported to attend a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (religious service or how they will be helped to go out. Staff tell us this person does not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (go to church and does not go out. In addition, the part of the care plan relating to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (people's death and dying needs states that this person should be encouraged to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (express their wishes regarding death as it approaches. This statement is used in all )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (the care plans we looked at where the section on death and dying had been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (completed. This person's plan makes no mention of the arrangements this person )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (might like in relation to their religion.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (Another person's care plan does not identify their social interests and we saw that this )Tj ET endstream endobj 55 0 obj<> endobj 56 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 57 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (22)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (person spent the day at the home in the lounge without being engaged in any activity.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (We asked staff how decisions are made about who gets up early or late. Staff told us )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm ('the diabetics are always got up first and that after that it depends on where the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (member of staff decides to start work'. This indicates that people are not offered )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (choice.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (We found that the care plan for one person contains a recently written statement that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (they like to get up at 6am. It also states that the nurse writing this has discussed this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (with the person and that they agree with this. This person is described in the care plan )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (as having dementia and being confused. We found this statement in the care plan of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (another person who is also described as having dementia. This means that people who )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (cannot speak up for themselves do not make decisions and do not have control over )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (their individual daily lives.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (Visitors told us they can visit when they like. And we saw visitors in the home at )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (different times of the day and evening. Some people say that staff keep them up to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (date with changes and developments and others say that staff don't do this.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (In surveys people told us they always like the food served in the home. People we )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (spoke with say they like the variety and the quality of food served. We heard staff )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (asking people what they would like for lunch, close to the time this was being served. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (This means that people are helped to make a choice about what to eat at a time when )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (they are ready to make this decision and when it means something to them. We were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (unsure how staff helped people who cannot speak for themselves to make decisions )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (about what to eat. We asked a member of care staff who told us that they get to know )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (what people like. We saw in care plans that there are records about some people's )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (likes and dislikes, but not for all people. We saw records relating to what one person )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (eats. We saw that they have porridge for breakfast every day as far back as we saw )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (records for \(approximately 11 weeks\). They had also had scrambled egg for supper for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (the majority of those 11 weeks. Staff told us that this person sometimes does not eat )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (much at supper and on the day of this inspection staff told us this person only ate 2 )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (small spoonfuls of supper. The records and conversations with staff do not indicate )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (that staff had explored the possibility that this person might be bored with their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (supper diet.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (We heard that one person who spends all their time in their bedroom had not had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (breakfast on two occasions and that their morning tea had been missed a couple of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (times.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm ()Tj ET endstream endobj 58 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 59 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (23)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 56.36 w 34.6 783.22 m 562.54 783.22 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 34.99 w 33.47 771.41 m 563.66 771.41 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 751.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 751.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 752.79 m 565.87 752.79 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (We also saw two people being supported to eat by staff whilst in their bedrooms. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (support given was unhurried, relaxed and sensitive. )Tj ET endstream endobj 60 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 61 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (24)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Complaints and protection )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 87.25 w 32.32 669.88 m 562.53 669.88 l S 0.001 w 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.65 680.63 l S 0.001 w 1 1 1 RG 17 w 31.2 635.88 m 563.65 635.88 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 645.5 m 565.85 645.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 645.5 m 565.85 645.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 626.25 m 565.85 626.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 625.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 625.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 Tm (If people have concerns with their care, they or people close to them know how to )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 685.57 Tm (complain. Any concern is looked into and action taken to put things right. The care )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.57 Tm (home safeguards people from abuse and neglect and takes action to follow up any )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.57 Tm (allegations.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 632.32 Tm (Peoples legal rights are protected, including being able to vote in elections.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 608 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 586 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 586 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 563.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 106.85 w 34.6 505.74 m 562.54 505.74 l S 0.001 w 1 1 1 RG 22.5 w 32.35 550.17 m 564.79 550.17 l S 0.001 w 84.36 w 33.47 494.5 m 563.66 494.5 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 537.8 m 565.87 537.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 538.88 m 32.35 450.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 538.88 m 564.79 450.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 537.8 m 564.79 537.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 451.19 m 565.87 451.19 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 546.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 522.12 Tm (poor)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 290.57 522.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 477.75 Tm (People concerns are not always acted upon and people are not fully safeguarded from )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 460.25 Tm (harm. )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 435.51 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 343.3 w 34.6 253.67 m 562.54 253.67 l S 0.001 w 1 1 1 RG 22.5 w 32.35 416.32 m 564.79 416.32 l S 0.001 w 321.93 w 33.47 241.86 m 563.66 241.86 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 403.95 m 565.87 403.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 405.03 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 405.03 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 403.95 m 564.79 403.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 413.01 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 388.27 Tm (In surveys all 3 people told us that they know how to make a formal complaint and 2 )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 370.77 Tm (told us there is someone they can speak with informally if they are not happy. One )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 353.27 Tm (person said they can only do this with their visitors.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 335.78 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 318.28 Tm (The information given to us in the AQAA tells us that this home has received one )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 300.79 Tm (complaint since the last inspection a year ago. This was dealt with by the home within )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 283.29 Tm (28 days, which is the timescale set, and it was upheld. It also tells us that one )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 265.79 Tm (safeguarding alert was made alleging that someone living at the home was not )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 248.3 Tm (receiving care that was safe. This was investigated by the safeguarding team in May )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 230.8 Tm (2009. The outcome of this was that the care provided was not neglectful or abusive, )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 213.31 Tm (but was poor practice.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 195.81 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 178.31 Tm (Since then the commission has received two complaints about the quality of care, )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 160.82 Tm (about staff not being available when needed, about the management of medicines and )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 143.32 Tm (about the general management of the home. One person said they had bought their )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 125.83 Tm (concerns to the attention of staff but did not get a satisfactory response. Another )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 108.33 Tm (person said they thought that staff were not taking their concerns seriously enough.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 90.83 Tm ()Tj ET endstream endobj 62 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 63 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (25)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (We have looked at some of these issues during this inspection and are working with )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (the safeguarding team who are undertaking an investigation relating to these )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (allegations. In addition Devon County Council are reviewing the care of the people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (living here.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (The AQAA tells us that no one living here is subject to any form of restraint. However, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (a referral was made under the Deprivation of Liberty and Mental Capacity Act because )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (one person is being restrained in their wheelchair. This is not a deprivation of liberty )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (but is a form of restraint. We saw that this continues. We also saw in a care plan that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (another person is restrained in their chair by using a lap belt when they try to stand )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (up. We saw that people have bed rails whilst in their beds, which is another form of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (restraint. There is some indication that the restraint used for people whilst sitting in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (their chairs might not always be appropriate. This is because records state that it is )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (used when people try to stand up or get agitated. The use of restraint is sometimes )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (the only action that can be taken to keep someone safe. However, records should )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (show that all other actions to reduce risk have been tried before this action is taken. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (In addition, care plans do not give clear and specific instructions as to when restraint )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (should be used and for how long. We asked staff about the use of restraint in the form )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (of a lap belt for one person. They told us that they use it only when needed, when )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (staff are not around, and for a few hours. This means that restraint is being used for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (long periods when staff are not around to supervise vulnerable and agitated people.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (People who live here are having decisions about forms of restraint made by staff or )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (relatives. Sometimes this has to happen if the person involved is not able to make )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (these decisions for themselves. The circumstances of these decisions should be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (recorded so that it is clear that these decisions are being made in the best interests of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (that person. Such records are not being kept for people living in this home.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (We saw three people who have bruises or broken skin. We asked staff about these. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (They gave us explanations for two but staff did not know what had caused the third )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (injury. We saw in care records that one person's injury had been caused when they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (had resisted care. The circumstances of this have not been investigated and actions )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (have not been taken to prevent this happening again. Another person injured them )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (self on a bed rail and there are no records to show that actions have been taken to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (prevent this happening again.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (We spoke with staff about what they would do if they saw or suspected abuse. They )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (told us they would tell the nurse in charge, as is good practice. We asked the nurse in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (charge what they would do, and the actions they describe are contrary to the guidance )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (given in the multi-agency guidance. This person told us that they had received )Tj ET endstream endobj 64 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 65 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (26)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 56.36 w 34.6 783.22 m 562.54 783.22 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 34.99 w 33.47 771.41 m 563.66 771.41 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 751.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 751.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 752.79 m 565.87 752.79 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (training and had a copy of the guidance in the home. However, the guidance they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (showed us would not guide them to take appropriate action if abuse were suspected. )Tj ET endstream endobj 66 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 67 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (27)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Environment )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 104.25 w 32.32 661.38 m 562.53 661.38 l S 0.001 w 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.65 697.63 l S 0.001 w 1 1 1 RG 68 w 31.2 644.38 m 563.65 644.38 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 679.5 m 565.85 679.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 679.5 m 565.85 679.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 609.25 m 565.85 609.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 608.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 608.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 Tm (People stay in a safe and well-maintained home that is homely, clean, pleasant and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 685.57 Tm (hygienic. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 666.32 Tm (People stay in a home that has enough space and facilities for them to lead the life )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 649.32 Tm (they choose and to meet their needs. The home makes sure they have the right )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 632.32 Tm (specialist equipment that encourages and promotes their independence. Their room )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 615.32 Tm (feels like their own, it is comfortable and they feel safe when they use it.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 591 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 569 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 569 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 546.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 106.85 w 34.6 488.74 m 562.54 488.74 l S 0.001 w 1 1 1 RG 22.5 w 32.35 533.17 m 564.79 533.17 l S 0.001 w 84.36 w 33.47 477.5 m 563.66 477.5 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 520.8 m 565.87 520.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 521.88 m 32.35 433.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 521.88 m 564.79 433.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 520.8 m 564.79 520.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 434.19 m 565.87 434.19 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 529.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 505.12 Tm (adequate)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 319.4 505.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 460.75 Tm (People living here enjoy a homely environment. However, improvements are needed )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 443.25 Tm (to ensure that people are fully protected from infection. )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 418.51 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 326.3 w 34.6 245.17 m 562.54 245.17 l S 0.001 w 1 1 1 RG 22.5 w 32.35 399.32 m 564.79 399.32 l S 0.001 w 304.93 w 33.47 233.36 m 563.66 233.36 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 386.95 m 565.87 386.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 388.03 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 388.03 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 386.95 m 564.79 386.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 396.01 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 371.27 Tm (In surveys people told us that the home is usually clean and fresh. On the day we )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 353.77 Tm (visited we found it to be clean and odour free.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 336.27 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 318.78 Tm (The home is warm, and is furnished and decorated in a domestic and homely style. )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 301.28 Tm (There is a reception area in the large hall, where there is usually a member of staff )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 283.79 Tm (during the day so that people visiting the home can speak with them. There is also a )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 266.29 Tm (large board in the hall displaying the photographs and names of the staff working at )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 248.79 Tm (the home. This is helpful so that people can identify and become familiar with staff.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 231.3 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 213.8 Tm (The home has one large lounge and a dining room. Both are decorated and furnished )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 196.31 Tm (in a homely style. The tables in the dining room are smaller and this helps people to )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 178.81 Tm (sit in smaller groups and to experience meals as a social occasion. The lounge is )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 161.31 Tm (divided into smaller seating areas so that people can carry out different activities )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 143.82 Tm (without disturbing others. This area is very bright as it has large windows to the side )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 126.32 Tm (and rear of the house.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 108.83 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 91.33 Tm (We saw staff washing their hands and wearing protective clothing as a way of helping )Tj ET endstream endobj 68 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 69 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (28)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 283.81 w 34.6 669.5 m 562.54 669.5 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 262.44 w 33.47 657.69 m 563.66 657.69 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 524.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 524.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 525.34 m 565.87 525.34 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (to prevent the spread of infection. Staff use alcohol gel as another way of preventing )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (the spread of infection, and this is also available for visitors to the home to use.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (However, we saw that the sluice did not have liquid soap for staff to wash their hands, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (and that some soap dispensers appear dirty and one was empty.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (Since the last inspection by the commission the home have also been visited by the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (fire authority. Some actions were required and these have been carried out. We saw )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (that access from the home is controlled at the front door by a key pad system and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (were told that this is linked to the fire alarm. This means that when the fire alarm )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (sounds that the door lock will automatically be opened, and is good practice.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (We were told that some areas of the home have been redecorated. We saw one )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (upstairs window being replaced. We saw that staff test and record the temperature of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (bathing water as is good practice to ensure that accidental scalding is prevented. )Tj ET endstream endobj 70 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 71 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (29)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Staffing )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 104.25 w 32.32 661.38 m 562.53 661.38 l S 0.001 w 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.65 672.13 l S 0.001 w 1 1 1 RG 17 w 31.2 618.88 m 563.65 618.88 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 609.25 m 565.85 609.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 608.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 608.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 Tm (People have safe and appropriate support as there are enough competent staff on duty )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 685.57 Tm (at all times. They have confidence in the staff at the home because checks have been )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.57 Tm (done to make sure that they are suitable to care for them. Their needs are met and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.57 Tm (they are cared for by staff who get the relevant training and support from their )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.57 Tm (managers.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 615.32 Tm (There are no additional outcomes.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 591 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 569 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 569 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 546.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 124.35 w 34.6 480 m 562.54 480 l S 0.001 w 1 1 1 RG 22.5 w 32.35 533.17 m 564.79 533.17 l S 0.001 w 101.85 w 33.47 468.75 m 563.66 468.75 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 520.8 m 565.87 520.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 521.88 m 32.35 415.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 521.88 m 564.79 415.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 520.8 m 564.79 520.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 416.7 m 565.87 416.7 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 529.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 505.12 Tm (poor)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 290.57 505.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 460.75 Tm (There are not always enough staff on duty with the appropriate qualifications, training )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 443.25 Tm (and skills to care for people living here. Practices in relation to recruitment are placing )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 425.76 Tm (people at risk of harm. )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 401.01 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 308.8 w 34.6 236.43 m 562.54 236.43 l S 0.001 w 1 1 1 RG 22.5 w 32.35 381.83 m 564.79 381.83 l S 0.001 w 287.43 w 33.47 224.62 m 563.66 224.62 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 369.45 m 565.87 369.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 370.53 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 370.53 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 369.45 m 564.79 369.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 378.52 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 353.77 Tm (This is a nursing home and should have a registered nurse on duty throughout the day )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 336.27 Tm (and night. We were contacted by a person who was concerned this was not )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 318.78 Tm (happening. We contacted the home and it was confirmed that on one night there was )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 301.28 Tm (not a nurse on duty. We asked the owner why they had not used an agency nurse to )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 283.79 Tm (cover this shift. They told us that this home never uses agency staff. They told us that )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 266.29 Tm (due to staff sickness they had arranged for a nurse to sleep at the home on that night. )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 248.79 Tm (This practice puts people at risk.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 231.3 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 213.8 Tm (The caller was also concerned that there are not enough staff on duty. We spoke to )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 196.31 Tm (the owner about this. She told us that staffing has been reduced but that there are )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 178.81 Tm (enough staff on duty to meet people's current needs. We looked at the duty rota and )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 161.31 Tm (saw that there had previously been 3 or 4 carers on duty in the morning and this had )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 143.82 Tm (been reduced to 2 or 3 carers. In the afternoon we saw that there used to be 2 or 3 )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 126.32 Tm (carers on duty in the afternoon, and now there are 2. On the day of this inspection )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 108.83 Tm (there was a nurse on duty with 3 carers, an administrator, cook and the temporary )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 91.33 Tm (manager.)Tj ET endstream endobj 72 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 73 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (30)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (We saw in the information given to us by the home prior to the inspection that there )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (are 14 people living at the home who need help with undressing and dressing, and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (need help to go to the toilet. 11 people are incontinent of both faeces and urine and 8 )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (people have dementia. 11 people need two members of staff to help them with their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (care.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (In surveys one person told us that staff are usually available, one that staff are )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (sometimes available and one that staff are never available when needed. Comments )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (included staff are not always available, and the home is very short of staff. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (surveys also asked what the home could do better. People said employ more staff who )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (can speak and understand English and train and employ more staff especially at night. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (Staff were however described as nice and lovely.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (We looked at the records relating to falls and injuries. According to these records )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (people have been found to have fallen when there have been no staff present on 14 )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (separate occasions since the beginning of July this year. This means that people are )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (not being sufficiently supervised by staff to keep them safe.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (We know that these accident records are incomplete. We are aware that one person )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (has fallen whilst alone, and this is not recorded. We also saw that two people had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (injuries which have not been recorded as accidents or incidents.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (We looked at the duty rota and found that is is not always accurate. For example, on )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (some weeks the manager, who has left the home, is recorded as on duty. In addition, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (the temporary manager has not been included on the duty rota until September )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (although they say they started work at the home in August.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (We asked to see the records of staff training. We were told that these are incomplete )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (because the records about training have gone missing since the manager left the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (home. We saw that some records had been made about training, but that there were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (large gaps. The management team tell us that this means they are not fully aware of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (what training staff have had, and what training might be needed. We did see a notice )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (that said that training has been arranged for staff in relation preventing people from )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (falling.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (Staff told us they had had some training. One told us they had had training in how to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (provide care to people, another that they thought they had had training in relation to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (supporting people who have problems with swallowing. However, they went on to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (describe training which relates to nutritional supplements. One person thought they )Tj ET endstream endobj 74 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 75 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (31)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 266.32 w 34.6 678.25 m 562.54 678.25 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 244.94 w 33.47 666.44 m 563.66 666.44 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 541.76 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 541.76 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 542.84 m 565.87 542.84 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (had had training about dementia, and gave a description of how to care for someone )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (with dementia which was an example of good practice.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (However, we also saw that staff record that people have drunk more than they have. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (We heard staff trying to persuade a confused person that their understanding of a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (situation was wrong, causing distress and confusion to this person. We also saw staff )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (ignoring one person who was trying to attract their attention.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (The AQAA told us that 10 of the 12 carers working at this home have achieved a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (National Vocational Qualification \(NVQ\) in care, to level 2 or above. We asked the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (manager if there is a system in place to ensure that staff practice the skills they are )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (taught, and to ensure they do this to the level of quality that is expected. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (manager told us that this is the nurses responsibility and that there is no formal )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (system.)Tj ET endstream endobj 76 0 obj<> endobj 77 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 78 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (32)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Management and administration )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 189.25 w 32.32 618.88 m 562.53 618.88 l S 0.001 w 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.65 672.13 l S 0.001 w 1 1 1 RG 102 w 31.2 576.38 m 563.65 576.38 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 524.25 m 565.85 524.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 523.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 523.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 Tm (People have confidence in the care home because it is led and managed appropriately. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 685.57 Tm (People control their own money and choose how they spend it. If they or someone )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.57 Tm (close to them cannot manage their money, it is managed by the care home in their )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.57 Tm (best interests. The environment is safe for people and staff because appropriate health )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.57 Tm (and safety practices are carried out.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 615.32 Tm (People get the right support from the care home because the manager runs it )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 598.32 Tm (appropriately with an open approach that makes them feel valued and respected. The )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 581.32 Tm (people staying at the home are safeguarded because it follows clear financial and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 564.32 Tm (accounting procedures, keeps records appropriately and ensures their staff understand )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 547.32 Tm (the way things should be done. They get the right care because the staff are )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 530.32 Tm (supervised and supported by their managers.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 506 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 484 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 484 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 461.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 124.35 w 34.6 395 m 562.54 395 l S 0.001 w 1 1 1 RG 22.5 w 32.35 448.17 m 564.79 448.17 l S 0.001 w 101.85 w 33.47 383.75 m 563.66 383.75 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 435.8 m 565.87 435.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 436.88 m 32.35 330.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 436.88 m 564.79 330.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 435.8 m 564.79 435.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 331.7 m 565.87 331.7 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 444.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 420.12 Tm (poor)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 290.57 420.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 375.75 Tm (Lack of leadership in this home means that systems are not in place to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 358.25 Tm (people receive the care they need to an acceptable standard in a way that promotes )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 340.76 Tm (their safety. )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 316.01 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 223.8 w 34.6 193.93 m 562.54 193.93 l S 0.001 w 1 1 1 RG 22.5 w 32.35 296.83 m 564.79 296.83 l S 0.001 w 202.43 w 33.47 182.12 m 563.66 182.12 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 284.45 m 565.87 284.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 285.53 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 285.53 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 284.45 m 564.79 284.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 293.52 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 268.77 Tm (This home does not have a Registered Manager. The previous manager left in August )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 251.27 Tm (2009. Since that time the home has been managed on a temporary basis. The )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 233.78 Tm (temporary manager is a Registered Nurse and is studying for a Leadership and )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 216.28 Tm (Management qualification. She had been working as the \(unregistered\) manager of )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 198.79 Tm (the owners' residential home, and works from 9am - 3pm four days weekly. She is )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 181.29 Tm (supernumerary to nursing hours and is supported by two of the four owners of this )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 163.79 Tm (home, who are also nurses.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 146.3 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 128.8 Tm (In the last few months the commission has received comments from relatives of )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 111.31 Tm (people living here who say the overall management of the home has declined. One )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 93.81 Tm (person described the management as chaotic, saying that this has resulted in people )Tj ET endstream endobj 79 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 80 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (33)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (not getting the care they need.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (We looked to see if there are systems in place to ensure the home runs efficiently and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (safely, and that people get the care they need. We found that systems are not robust )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (enough to achieve this.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (For example we looked at the system for communicating peoples' needs and changing )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (needs, and for ensuring that peoples' needs are met. The owners and manager told us )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (that this is achieved through the care planning system. However, we found that these )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (documents are complex and contradictory in places. They do not always provide the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (level of detail needed by staff to ensure that they have the information they need, and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (to ensure that people's needs are met in a way that is consistent and of a satisfactory )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (quality. We found that reviews of people's care do not include all the information )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (available and do not always provide evidence for some of the care decisions made )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (\(see Health and Personal Care\). Care staff told us they do not read care plans. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (asked if they got a hand over of information at the beginning of each shift and they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (told us they do not. We asked the manager how information is relayed to staff. She )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (told us that she expects the nurses to do this. The evidence in the Health and Personal )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (Care section of this report, shows that this is not happening.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (We looked closely at how some decisions about people's care are made. For example, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (one record states that one person cannot make a decision about having bed rails on )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (their bed. However, records show that this person has made a decision about having )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (repeated invasive procedures. Another person can make the decision to get up at 6am )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (but cannot make a decision about what they eat.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (We looked at how risks in the home are managed. We found that people are identified )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (as being at risk of falling. Care records instruct staff to observe them. Records show )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (that a lot of falls have happened to people when staff are not present. Although there )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (is a system for recording this information, there is not a system for monitoring and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (analysing this information, and therefore actions have not been taken to help prevent )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (and reduce the number of falls.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (We looked to see if there is a safe system in place for moving and handling people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (with mobility problems. We found that assessments have not been carried out or had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (been carried out a long time ago and have not been reviewed. We found that decisions )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (about the type of equipment to be used are based on the equipment that is available )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (and not on what would be the most suitable for each person. The manager reports )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (that staff have not had training in how to carry out moving and handling assessments.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm ()Tj ET endstream endobj 81 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 82 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (34)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (We looked at how other risks in the home have been managed. We found that the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (temperature of hot water is restricted to help ensure that people are not scalded. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (found that windows have restricted openings to prevent people falling. However, we )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (found one window, that had been replaced that day, did not have a restricted opening. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (We told one of the owners who told us they thought that it had been restricted since )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (we last looked. When we looked again, it had not.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (We looked in the kitchen and found it clean and tidy. The owners identified )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (approximately 4 years ago that the kitchen is coming to the end of its useful life, and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (the Environmental Health Officer also identified this. The cook reports that a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (refurbishment date has not yet been set.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (We looked at how equipment is maintained. We found that the weighing scales had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (been weighing inaccurately for some time meaning that people at risk of malnutrition )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (could not be weighed accurately. The lift broke down for at least 2 days in October.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (We looked at how the home involve people in the running of the home and how the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (management team get feedback from people and improve the quality of care given. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (We were told by relatives that meetings are sometimes held to which they are invited. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (One person told us at that at the last meeting they had been informed there were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (going to be a lot of changes in the home. They asked for, and the management team )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (agreed they could have, a list of these changes so that they could prepare their parent )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (for these changes. They have not received this.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (We looked at the results of the most recent quality assurance survey \(June 2009\). )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (Some people had said they were not satisfied with the length of time it took to answer )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (call bells. One person said that new staff were not given enough training meaning that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (they had to take instruction from the person they were meant to be caring for. Two )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (people thought that improvements should be made to laundry and one to ironing. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (asked how these issues had been addressed and the owner did not know because the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (survey was carried out when the previous manager was employed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (We checked to see if previous requirements set by the commission have been met. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (We found that requirements relating to health and welfare, care planning, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (safeguarding people, meeting people's social needs, staff skills and improving the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (overall management have not been met.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (We did not check any personal allowance accounts of the people living here as the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (home does not hold any money on behalf of people. Instead they run a debit account, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (recording all monies spent on people's behalf. Records and receipts are given to )Tj ET endstream endobj 83 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 84 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (35)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 126.35 w 34.6 748.23 m 562.54 748.23 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 104.98 w 33.47 736.42 m 563.66 736.42 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 681.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 681.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 682.81 m 565.87 682.81 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (relatives and supporters for them to check and to pay for retrospectively.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (During our inspection it came to light that the commission are not being notified of all )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (incidents that affect the welfare of people living here as they should be. In addition )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (the owners of the home have not been carrying out monthly unannounced visits to the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (home as they should, They have since informed us that they plan to restart these. )Tj ET endstream endobj 85 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 86 0 obj<> endobj 87 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (36)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.99216 0.9451 0.76078 RG 36.25 w 29.47 793.28 m 564.97 793.28 l S 0.001 w 0.95294 0.95294 0.95294 RG 17 w 28.35 804.03 m 566.1 804.03 l S 0.001 w 17 w 28.35 784.78 m 422.1 784.78 l S 0.001 w 17 w 424.35 784.78 m 467.1 784.78 l S 0.001 w 1 1 1 RG 17 w 469.35 784.78 m 494.1 784.78 l S 0.001 w 0.95294 0.95294 0.95294 RG 17 w 496.35 784.78 m 539.1 784.78 l S 0.001 w 1 1 1 RG 17 w 541.35 784.78 m 566.1 784.78 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 26.14 794.4 m 568.3 794.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 813.65 m 568.3 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 794.4 m 568.3 794.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 775.15 m 568.3 775.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.22 814.73 m 27.22 774.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 423.22 795.48 m 423.22 774.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 468.22 795.48 m 468.22 774.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 495.22 795.48 m 495.22 774.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 540.22 795.48 m 540.22 774.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 814.73 m 567.22 774.08 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 33.75 800.47 Tm (Are there any outstanding requirements from the last inspection?)Tj ET /F2 12 Tf BT 1 0 0 1 429.75 781.22 Tm (Yes)Tj ET /F7 12 Tf BT 1 0 0 1 476.37 783.16 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 501.75 781.22 Tm (No)Tj ET /F7 12 Tf BT 1 0 0 1 546.75 783.16 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 654.5 w 32.32 391.28 m 564.97 391.28 l S 0.001 w 1 1 1 RG 183.96 w 31.2 523.69 m 91.05 523.69 l S 0.001 w 183.96 w 93.3 523.69 m 197.4 523.69 l S 0.001 w 183.96 w 199.65 523.69 m 289.45 523.69 l S 0.001 w 183.96 w 291.7 523.69 m 473.8 523.69 l S 0.001 w 183.96 w 476.05 523.69 m 566.1 523.69 l S 0.001 w 300.6 w 31.2 279.16 m 91.05 279.16 l S 0.001 w 300.6 w 93.3 279.16 m 197.4 279.16 l S 0.001 w 300.6 w 199.65 279.16 m 289.45 279.16 l S 0.001 w 300.6 w 291.7 279.16 m 473.8 279.16 l S 0.001 w 300.6 w 476.05 279.16 m 566.1 279.16 l S 0.001 w 63.71 w 31.2 94.76 m 91.05 94.76 l S 0.001 w 63.71 w 93.3 94.76 m 197.4 94.76 l S 0.001 w 63.71 w 199.65 94.76 m 289.45 94.76 l S 0.001 w 63.71 w 291.7 94.76 m 473.8 94.76 l S 0.001 w 63.71 w 476.05 94.76 m 566.1 94.76 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 430.59 m 568.3 430.59 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 127.74 m 568.3 127.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 617.88 m 30.07 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 617.88 m 567.22 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 649.35 m 568.4 649.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 616.8 m 568.3 616.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 617.88 m 92.17 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 617.88 m 198.52 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 617.88 m 290.57 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 617.88 m 474.92 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 720.78 m 568.4 720.78 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 649.35 m 568.4 649.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 616.8 m 568.4 616.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 430.59 m 568.3 430.59 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 127.74 m 568.3 127.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 61.78 m 568.3 61.78 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 721.86 m 30.07 615.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 650.43 m 92.12 615.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 650.43 m 198.52 615.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 650.43 m 290.62 615.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 650.43 m 475.02 615.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 721.86 m 567.32 615.72 l S 0.001 w [] 0 d /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 703.57 Tm (Outstanding statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 685.15 Tm (These are requirements that were set at the previous inspection, but have still not )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 670.57 Tm (been met.)Tj ET /F2 12 Tf BT 1 0 0 1 95.57 670.57 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 104.02 670.57 Tm (They say what the registered person had to do to meet the Care Standards )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 655.99 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 638.17 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 635.17 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 635.17 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 635.17 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 635.17 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 623.02 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 603.61 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 600.61 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 600.61 Tm (15)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 600.61 Tm (\(1\) People who have )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 586.03 Tm (dementia must have their )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 571.45 Tm (care planned in a way that is )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 556.87 Tm (person centred; identifying )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 542.29 Tm (all their needs and detailing )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 527.71 Tm (how these needs should be )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 513.13 Tm (met. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 495.55 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 480.97 Tm (By doing this people with )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 466.39 Tm (dementia will have their )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 451.81 Tm (needs better understood and )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 437.23 Tm (met. )Tj ET /F2 12 Tf BT 1 0 0 1 478.9 600.61 Tm (20/02/2009)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 417.4 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 414.4 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 414.4 Tm (15 \(1\))Tj ET /F2 12 Tf BT 1 0 0 1 294.55 414.4 Tm (People who have dementia )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 399.82 Tm (must have their care planned )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 385.24 Tm (in a way that is person )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 370.66 Tm (centred; identifying all their )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 356.08 Tm (needs and detailing how )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 341.5 Tm (these needs should be met.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 326.92 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 312.34 Tm (Care given must be reviewed )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 297.76 Tm (in a way that helps the care )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 283.18 Tm (planner to make a )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 268.6 Tm (judgement about whether )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 254.02 Tm (the planned care is meeting )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 239.44 Tm (that persons needs.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 224.86 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 210.28 Tm (Previous timescale of )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 195.7 Tm (31/03/08 not met.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 181.12 Tm (Not inspected on this )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 166.54 Tm (occasion. Previous timescale )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 151.96 Tm (11/07/08)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 134.38 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 478.9 414.4 Tm (31/07/2008)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 114.55 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 111.55 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 111.55 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 111.55 Tm (\(1\) \(a\) When there is )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 96.97 Tm (concern that someones )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 82.39 Tm (health may be affected, for )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 67.81 Tm (example they are losing )Tj ET /F2 12 Tf BT 1 0 0 1 478.9 111.55 Tm (23/01/2009)Tj ET endstream endobj 88 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 89 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (37)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 727.68 w 32.32 447.56 m 564.97 447.56 l S 0.001 w 1 1 1 RG 125.64 w 31.2 645.73 m 91.05 645.73 l S 0.001 w 125.64 w 93.3 645.73 m 197.4 645.73 l S 0.001 w 125.64 w 199.65 645.73 m 289.45 645.73 l S 0.001 w 125.64 w 291.7 645.73 m 473.8 645.73 l S 0.001 w 125.64 w 476.05 645.73 m 566.1 645.73 l S 0.001 w 213.12 w 31.2 474.1 m 91.05 474.1 l S 0.001 w 213.12 w 93.3 474.1 m 197.4 474.1 l S 0.001 w 213.12 w 199.65 474.1 m 289.45 474.1 l S 0.001 w 213.12 w 291.7 474.1 m 473.8 474.1 l S 0.001 w 213.12 w 476.05 474.1 m 566.1 474.1 l S 0.001 w 140.22 w 31.2 295.18 m 91.05 295.18 l S 0.001 w 140.22 w 93.3 295.18 m 197.4 295.18 l S 0.001 w 140.22 w 199.65 295.18 m 289.45 295.18 l S 0.001 w 140.22 w 291.7 295.18 m 473.8 295.18 l S 0.001 w 140.22 w 476.05 295.18 m 566.1 295.18 l S 0.001 w 140.22 w 31.2 152.71 m 91.05 152.71 l S 0.001 w 140.22 w 93.3 152.71 m 197.4 152.71 l S 0.001 w 140.22 w 199.65 152.71 m 289.45 152.71 l S 0.001 w 140.22 w 291.7 152.71 m 473.8 152.71 l S 0.001 w 140.22 w 476.05 152.71 m 566.1 152.71 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 581.78 m 568.3 581.78 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 366.41 m 568.3 366.41 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 223.94 m 568.3 223.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 710.75 m 30.07 80.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 710.75 m 567.22 80.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 742.22 m 568.4 742.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 709.67 m 568.3 709.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 710.75 m 92.17 80.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 710.75 m 198.52 80.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 710.75 m 290.57 80.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 710.75 m 474.92 80.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 742.22 m 568.4 742.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 709.67 m 568.4 709.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 581.78 m 568.3 581.78 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 366.41 m 568.3 366.41 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 223.94 m 568.3 223.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 81.47 m 568.3 81.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 708.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 743.3 m 92.12 708.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 743.3 m 198.52 708.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 743.3 m 290.62 708.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 743.3 m 475.02 708.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 708.6 l S 0.001 w [] 0 d /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 796.45 Tm (Outstanding statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 778.03 Tm (These are requirements that were set at the previous inspection, but have still not )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 763.45 Tm (been met.)Tj ET /F2 12 Tf BT 1 0 0 1 95.57 763.45 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 104.02 763.45 Tm (They say what the registered person had to do to meet the Care Standards )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 748.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 731.05 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 728.05 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 728.05 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 728.05 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 728.05 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 715.9 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 292.3 698.74 Tm (weight, appropriate actions )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 684.16 Tm (must be taken to address )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 669.58 Tm (this. )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 649 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 292.3 634.42 Tm (In this way appropriate )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 619.84 Tm (actions will be taken to )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 605.26 Tm (prevent or limit as far as )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 590.68 Tm (possible health deterioration. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 568.6 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 565.6 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 565.6 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 565.6 Tm (\(1\) \(a\) People with dementia )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 551.02 Tm (must have their mental )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 536.44 Tm (health and welfare needs )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 521.86 Tm (met. This includes working )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 507.28 Tm (towards understanding what )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 492.7 Tm (people with dementia are )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 478.12 Tm (trying to communicate and )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 463.54 Tm (taking action to address what )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 448.96 Tm (is being communicated.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 431.38 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 416.8 Tm (In this way each individual )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 402.22 Tm (with dementia will have their )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 387.64 Tm (mental health and welfare )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 373.06 Tm (needs understood and met. )Tj ET /F2 12 Tf BT 1 0 0 1 478.9 565.6 Tm (20/02/2009)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 353.23 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 350.23 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 350.23 Tm (16)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 350.23 Tm (\(2\) \(m\) \(n\) People must )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 335.65 Tm (have their social needs and )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 321.07 Tm (interests identified and you )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 306.49 Tm (must make arrangements to )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 291.91 Tm (enable these to be met. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 274.33 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 259.75 Tm (This will help to improve the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 245.17 Tm (quality of life of the people )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 230.59 Tm (living here. )Tj ET /F2 12 Tf BT 1 0 0 1 478.9 350.23 Tm (20/02/2009)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 210.76 Tm (6)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 207.76 Tm (30)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 207.76 Tm (18)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 207.76 Tm (\(1\) \(a\) People with dementia )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 193.18 Tm (must be supported by people )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 178.6 Tm (who are suitably qualified )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 164.02 Tm (and competent in this area of )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 149.44 Tm (care. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 131.86 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 117.28 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 102.7 Tm (the needs of people with )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 88.12 Tm (dementia are met. )Tj ET /F2 12 Tf BT 1 0 0 1 478.9 207.76 Tm (13/02/2009)Tj ET endstream endobj 90 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 91 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (38)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 530.22 w 32.32 546.29 m 564.97 546.29 l S 0.001 w 1 1 1 RG 140.22 w 31.2 638.44 m 91.05 638.44 l S 0.001 w 140.22 w 93.3 638.44 m 197.4 638.44 l S 0.001 w 140.22 w 199.65 638.44 m 289.45 638.44 l S 0.001 w 140.22 w 291.7 638.44 m 473.8 638.44 l S 0.001 w 140.22 w 476.05 638.44 m 566.1 638.44 l S 0.001 w 286.02 w 31.2 423.07 m 91.05 423.07 l S 0.001 w 286.02 w 93.3 423.07 m 197.4 423.07 l S 0.001 w 286.02 w 199.65 423.07 m 289.45 423.07 l S 0.001 w 286.02 w 291.7 423.07 m 473.8 423.07 l S 0.001 w 286.02 w 476.05 423.07 m 566.1 423.07 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 567.2 m 568.3 567.2 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 710.75 m 30.07 277.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 710.75 m 567.22 277.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 742.22 m 568.4 742.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 709.67 m 568.3 709.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 710.75 m 92.17 277.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 710.75 m 198.52 277.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 710.75 m 290.57 277.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 710.75 m 474.92 277.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 742.22 m 568.4 742.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 709.67 m 568.4 709.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 567.2 m 568.3 567.2 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 278.93 m 568.3 278.93 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 708.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 743.3 m 92.12 708.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 743.3 m 198.52 708.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 743.3 m 290.62 708.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 743.3 m 475.02 708.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 708.6 l S 0.001 w [] 0 d /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 796.45 Tm (Outstanding statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 778.03 Tm (These are requirements that were set at the previous inspection, but have still not )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 763.45 Tm (been met.)Tj ET /F2 12 Tf BT 1 0 0 1 95.57 763.45 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 104.02 763.45 Tm (They say what the registered person had to do to meet the Care Standards )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 748.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 731.05 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 728.05 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 728.05 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 728.05 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 728.05 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 715.9 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 696.49 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 693.49 Tm (31)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 693.49 Tm (10)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 693.49 Tm (\(1\) \(a\) The management of )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 678.91 Tm (this home should manage )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 664.33 Tm (the home with sufficient )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 649.75 Tm (care, competence and skill. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 632.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 617.59 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 603.01 Tm (the health and welfare needs )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 588.43 Tm (of each person living here )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 573.85 Tm (are met. )Tj ET /F2 12 Tf BT 1 0 0 1 478.9 693.49 Tm (13/02/2009)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 554.02 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 551.02 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 551.02 Tm (26)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 551.02 Tm (The providers must visit the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 536.44 Tm (home at least once monthly )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 521.86 Tm (on an unannounced basis. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 507.28 Tm (They must do this so that )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 492.7 Tm (they can form an opinion as )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 478.12 Tm (to the standard of care )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 463.54 Tm (provided in the home. They )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 448.96 Tm (must record their findings )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 434.38 Tm (and send these to the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 419.8 Tm (commission after each visit.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 405.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 390.64 Tm (Previous timescale of )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 376.06 Tm (13/04/07 not met.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 361.48 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 346.9 Tm (Not inspected on this )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 332.32 Tm (occasion. Previous timescale )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 317.74 Tm (31/12/07.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 303.16 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 285.58 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 478.9 551.02 Tm (31/07/2008)Tj ET endstream endobj 92 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 93 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (39)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 797.57 Tm (Requirements and recommendations from this inspection:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 782.15 Tm ()Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 108.12 w 32.32 719.78 m 564.97 719.78 l S 0.001 w 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 0.001 w 20.58 w 93.3 677.13 m 197.4 677.13 l S 0.001 w 20.58 w 199.65 677.13 m 289.45 677.13 l S 0.001 w 20.58 w 291.7 677.13 m 473.8 677.13 l S 0.001 w 20.58 w 476.05 677.13 m 566.1 677.13 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 30.07 689.63 m 30.07 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 689.63 m 567.22 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 721.1 m 568.4 721.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 688.55 m 568.3 688.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 689.63 m 92.17 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 689.63 m 198.52 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 689.63 m 290.57 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 689.63 m 474.92 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 776.09 m 568.4 776.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 721.1 m 568.4 721.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 688.55 m 568.4 688.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 665.72 m 568.3 665.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 777.17 m 30.07 687.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 722.18 m 92.12 687.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 722.18 m 198.52 687.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 722.18 m 290.62 687.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 722.18 m 475.02 687.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 777.17 m 567.32 687.47 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 759.9 Tm (Immediate requirements:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 742.32 Tm (These are immediate requirements that were set on the day we visited this care home. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 727.74 Tm (The registered person had to meet these within 48 hours.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 709.92 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 706.92 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 706.92 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 706.92 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 706.92 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 694.77 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 675.36 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 96.15 672.36 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 202.5 672.36 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 672.36 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 478.9 672.36 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32 345.62 m 564.97 345.62 l S 0.001 w 1 1 1 RG 238 w 31.2 407.8 m 91.05 407.8 l S 0.001 w 238 w 93.3 407.8 m 197.4 407.8 l S 0.001 w 238 w 199.65 407.8 m 289.45 407.8 l S 0.001 w 238 w 291.7 407.8 m 473.8 407.8 l S 0.001 w 238 w 476.05 407.8 m 566.1 407.8 l S 0.001 w 223.65 w 31.2 174.73 m 91.05 174.73 l S 0.001 w 223.65 w 93.3 174.73 m 197.4 174.73 l S 0.001 w 223.65 w 199.65 174.73 m 289.45 174.73 l S 0.001 w 223.65 w 291.7 174.73 m 473.8 174.73 l S 0.001 w 223.65 w 476.05 174.73 m 566.1 174.73 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 287.68 m 568.3 287.68 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 529.01 m 30.07 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 529.01 m 567.22 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 560.48 m 568.4 560.48 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 527.93 m 568.3 527.93 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 529.01 m 92.17 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 529.01 m 198.52 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 529.01 m 290.57 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 529.01 m 474.92 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 629.47 m 568.4 629.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 560.48 m 568.4 560.48 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 527.93 m 568.4 527.93 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 287.68 m 568.3 287.68 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 61.78 m 568.3 61.78 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 630.55 m 30.07 526.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 561.56 m 92.12 526.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 561.56 m 198.52 526.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 561.56 m 290.62 526.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 561.56 m 475.02 526.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 630.55 m 567.32 526.85 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 616.28 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 596.28 Tm (These requirements set out what the registered person must do to meet the Care )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 581.7 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 581.7 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 567.12 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 549.3 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 546.3 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 546.3 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 546.3 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 546.3 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 534.15 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 514.74 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 514.74 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 514.74 Tm (14)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 514.74 Tm (People must not be admitted )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 497.74 Tm (to this home unless their )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 480.74 Tm (needs have been assessed )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 463.74 Tm (by a suitable person. This )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 446.74 Tm (assessment must include )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 429.74 Tm (health and social care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 412.74 Tm (assessments if the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 395.74 Tm (placement takes place )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 378.74 Tm (through health or social care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 361.74 Tm (services. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 344.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 327.74 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 310.74 Tm (each person's needs are )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 293.74 Tm (identified and can be met. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 514.74 Tm (07/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 514.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 274.49 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 274.49 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 274.49 Tm (15)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 274.49 Tm (You must ensure that care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 257.49 Tm (plans provide clear and up )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 240.49 Tm (to date instructions on how )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 223.49 Tm (each person's care needs )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 206.49 Tm (are to be met, recorded and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 189.49 Tm (monitored. Information )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 172.49 Tm (recorded in care plans must )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 155.49 Tm (be relevant and appropriate. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 138.49 Tm (All parts of the care plan )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 121.49 Tm (must be reviewed and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 104.49 Tm (updated as appropriate. All )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 87.49 Tm (irrelevant parts of the care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 70.49 Tm (plan must be removed. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 274.49 Tm (07/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 274.49 Tm ()Tj ET endstream endobj 94 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 95 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (40)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 732.79 w 32.32 445.01 m 564.97 445.01 l S 0.001 w 1 1 1 RG 102 w 31.2 659.99 m 91.05 659.99 l S 0.001 w 102 w 93.3 659.99 m 197.4 659.99 l S 0.001 w 102 w 199.65 659.99 m 289.45 659.99 l S 0.001 w 102 w 291.7 659.99 m 473.8 659.99 l S 0.001 w 102 w 476.05 659.99 m 566.1 659.99 l S 0.001 w 374 w 31.2 419.74 m 91.05 419.74 l S 0.001 w 374 w 93.3 419.74 m 197.4 419.74 l S 0.001 w 374 w 199.65 419.74 m 289.45 419.74 l S 0.001 w 374 w 291.7 419.74 m 473.8 419.74 l S 0.001 w 374 w 476.05 419.74 m 566.1 419.74 l S 0.001 w 153 w 31.2 153.99 m 91.05 153.99 l S 0.001 w 153 w 93.3 153.99 m 197.4 153.99 l S 0.001 w 153 w 199.65 153.99 m 289.45 153.99 l S 0.001 w 153 w 291.7 153.99 m 473.8 153.99 l S 0.001 w 153 w 476.05 153.99 m 566.1 153.99 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 607.86 m 568.3 607.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 231.61 m 568.3 231.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 607.86 m 568.3 607.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 231.61 m 568.3 231.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 76.36 m 568.3 76.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 Tm (These requirements set out what the registered person must do to meet the Care )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 295.8 701.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 295.8 684.18 Tm (By doing this staff will have )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 667.18 Tm (the information they need to )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 650.18 Tm (ensure that people have )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 633.18 Tm (their needs better )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 616.18 Tm (understood and met. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 594.68 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 594.68 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 594.68 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.68 Tm (You must ensure that there )Tj ET 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requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 Tm (These requirements set out what the registered person must do to meet the Care )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 295.8 701.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 295.8 684.18 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 667.18 Tm (people are supported to )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 650.18 Tm (remain healthy. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 628.68 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 628.68 Tm (16)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 628.68 Tm (22)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 628.68 Tm (The complaints procedure )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 611.68 Tm (should be appropriate to the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.68 Tm (needs of the people who live )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm (here and concerns raised )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm (must be investigated )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm (thoroughly and actions )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (taken to address the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (findings. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.68 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.68 Tm (concerns are taken seriously )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 441.68 Tm (and acted upon. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 628.68 Tm (31/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 628.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 422.43 Tm (10)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 422.43 Tm (18)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 422.43 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 422.43 Tm (Staff must be aware of the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 405.43 Tm (reporting procedures )Tj ET /F2 12 Tf BT 1 0 0 1 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are in place. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 182.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 165.18 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 148.18 Tm (the spread of any infections )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 131.18 Tm (are limited as far as )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 114.18 Tm (possible. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 233.18 Tm (07/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 233.18 Tm ()Tj ET endstream endobj 101 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 102 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (43)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 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)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 698.93 Tm (31/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 698.93 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 577.68 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 577.68 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 577.68 Tm (19)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm (You must ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm (recruitment procedures are )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm (robust.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm (people are cared for by )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.68 Tm (appropriate staff. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 577.68 Tm (31/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 577.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 456.43 Tm (14)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 456.43 Tm (31)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 456.43 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 456.43 Tm (An application must be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 439.43 Tm (made to register a manager )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 422.43 Tm (for this home. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 405.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 388.43 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 371.43 Tm (people benefit from living in )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 354.43 Tm (a home that is managed by )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 337.43 Tm (a suitable and from )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 320.43 Tm (management systems that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 303.43 Tm (help to ensure people's )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 286.43 Tm (safety and well being. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 456.43 Tm (07/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 456.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 267.18 Tm (15)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 267.18 Tm (33)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 267.18 Tm (24)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 267.18 Tm (Results of the system for )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 250.18 Tm (monitoring the quality of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 233.18 Tm (care should be acted upon. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 216.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 199.18 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 182.18 Tm (people are involved in the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 165.18 Tm (running of the home and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 148.18 Tm (that actions are taken to )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 131.18 Tm (improve the quality of care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 114.18 Tm (provided in the home. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 267.18 Tm (26/02/2010)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 267.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 94.93 Tm (16)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 94.93 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 94.93 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 94.93 Tm (Risks to people living here, )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 77.93 Tm (to include but not exclusive )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 94.93 Tm (29/01/2010)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 94.93 Tm ()Tj ET endstream endobj 103 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 104 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (44)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 746.25 w 32.32 438.28 m 564.97 438.28 l S 0.001 w 1 1 1 RG 119 w 31.2 651.49 m 91.05 651.49 l S 0.001 w 119 w 93.3 651.49 m 197.4 651.49 l S 0.001 w 119 w 199.65 651.49 m 289.45 651.49 l S 0.001 w 119 w 291.7 651.49 m 473.8 651.49 l S 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The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 295.8 701.18 Tm (to, the risk of falling should )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 684.18 Tm (be identified and as far as )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 667.18 Tm (possible should be )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 650.18 Tm (eliminated. )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 633.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 295.8 616.18 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 599.18 Tm (people are kept safe. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 577.68 Tm (17)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 577.68 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 577.68 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm (You must ensure that the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm (health and welfare needs of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm (people living here are met. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (This must include, but is not )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (exclusive to, moving and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm (handling people safely, )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.68 Tm (maintaining equipment and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.68 Tm (restricting window openings )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 441.68 Tm (as appropriate. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 424.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 407.68 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 390.68 Tm (people living here are kept )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 373.68 Tm (safe through safe working )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 356.68 Tm (practices. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 577.68 Tm (07/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 577.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 337.43 Tm (18)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 337.43 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 337.43 Tm (26)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 337.43 Tm (The providers must visit the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 320.43 Tm (home at least once monthly )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 303.43 Tm (on an unannounced basis.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 286.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 269.43 Tm (They should do this to help )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 252.43 Tm (them to form an opinion as )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 235.43 Tm (to the standard of care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 218.43 Tm (provided in the home. They )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 201.43 Tm (must record their findings )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 184.43 Tm (and send these to the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 167.43 Tm (commission after each visit. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 337.43 Tm (07/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 337.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 148.18 Tm (19)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 148.18 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 148.18 Tm (23)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 148.18 Tm (You must ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 131.18 Tm (equipment provided at the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 114.18 Tm (home for use by people )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 97.18 Tm (living here is maintained in )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 80.18 Tm (good working order. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 148.18 Tm (31/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 148.18 Tm ()Tj ET endstream endobj 105 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 106 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (45)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 305.54 w 32.32 658.63 m 564.97 658.63 l S 0.001 w 1 1 1 RG 68 w 31.2 676.99 m 91.05 676.99 l S 0.001 w 68 w 93.3 676.99 m 197.4 676.99 l S 0.001 w 68 w 199.65 676.99 m 289.45 676.99 l S 0.001 w 68 w 291.7 676.99 m 473.8 676.99 l S 0.001 w 68 w 476.05 676.99 m 566.1 676.99 l S 0.001 w 136 w 31.2 572.74 m 91.05 572.74 l S 0.001 w 136 w 93.3 572.74 m 197.4 572.74 l S 0.001 w 136 w 199.65 572.74 m 289.45 572.74 l S 0.001 w 136 w 291.7 572.74 m 473.8 572.74 l S 0.001 w 136 w 476.05 572.74 m 566.1 572.74 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 641.86 m 568.3 641.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 502.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 502.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 502.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 502.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 502.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 502.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 641.86 m 568.3 641.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 503.61 m 568.3 503.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 Tm (These requirements set out what the registered person must do to meet the Care )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 295.8 701.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 295.8 684.18 Tm (This will help to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 667.18 Tm (people living in the home )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 650.18 Tm (are safe. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 628.68 Tm (20)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 628.68 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 628.68 Tm (37)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 628.68 Tm (All incidents and events, )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 611.68 Tm (including deaths, must be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.68 Tm (reported to the commission. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm (This will ensure that the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm (commission are kept up to )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (date about events in the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (home. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 628.68 Tm (07/12/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 628.68 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 267.64 w 32.32 349.42 m 564.97 349.42 l S 0.001 w 1 1 1 RG 49.74 w 31.2 370.65 m 91.05 370.65 l S 0.001 w 49.74 w 93.3 370.65 m 197.4 370.65 l S 0.001 w 49.74 w 199.65 370.65 m 566.1 370.65 l S 0.001 w 49.74 w 31.2 318.66 m 91.05 318.66 l S 0.001 w 49.74 w 93.3 318.66 m 197.4 318.66 l S 0.001 w 49.74 w 199.65 318.66 m 566.1 318.66 l S 0.001 w 35.16 w 31.2 273.96 m 91.05 273.96 l S 0.001 w 35.16 w 93.3 273.96 m 197.4 273.96 l S 0.001 w 35.16 w 199.65 273.96 m 566.1 273.96 l S 0.001 w 35.16 w 31.2 236.55 m 91.05 236.55 l S 0.001 w 35.16 w 93.3 236.55 m 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l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 486.57 m 30.07 395.57 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 417 m 92.17 396.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.47 417 m 198.47 396.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 486.57 m 567.32 395.57 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 469.3 Tm (Recommendations)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 451.72 Tm (These recommendations are taken from the best practice described in the National )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 437.14 Tm (Minimum Standards and the registered person\(s\) should consider them as a way of )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 422.56 Tm (improving their service.)Tj ET /F2 10 Tf BT 1 0 0 1 34.05 401.74 Tm (No)Tj ET /F2 10 Tf BT 1 0 0 1 96.15 401.74 Tm (Refer to Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.45 401.74 Tm (Good Practice Recommendations)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 380.46 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 380.46 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 380.46 Tm (Where someone cannot swallow medicines, actions should )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 365.88 Tm (be taken to find out if the required medicines are available )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 351.3 Tm (in another, for example liquid, form. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 328.47 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 328.47 Tm (18)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 328.47 Tm (Injuries sustained by people must be fully investigated and )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 313.89 Tm (appropriate actions must be taken to protect people from )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 299.31 Tm (injury. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 276.48 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 276.48 Tm (27)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 276.48 Tm (You must ensure that the duty rota always shows )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 261.9 Tm (accurately who is on duty and in what capacity. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 239.07 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 239.07 Tm (30)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 239.07 Tm (You must ensure that staff have had the training they need )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 224.49 Tm (to care for people appropriately.)Tj ET endstream endobj 107 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 108 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 22.5 w 22.95 802.41 m 560.45 802.41 l S 0.001 w /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 799.09 Tm (Helpline:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 28.35 781.11 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 759.6 Tm (Telephone:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 95.88 759.6 Tm ( 03000 616161)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 739.6 Tm (Email:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 66.84 739.6 Tm ( enquiries@cqc.org.uk)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 719.61 Tm (Web:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 64.35 719.61 Tm (www.cqc.org.uk)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 699.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 679.61 Tm (We want people to be able to access this information. If you would like a summary in a )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 662.12 Tm (different format or language please contact our helpline or go to our website.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 622.62 Tm (Copyright \(2009\) Care Quality Commission \(CQC\). This publication may be )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium provided that it )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 587.63 Tm (is not used for commercial gain. This consent is subject to the material being )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory manner or )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 552.64 Tm (misleading context. 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/W put dup 88 /X put dup 89 /Y put dup 90 /Z put dup 91 /bracketleft put dup 92 /backslash put dup 93 /bracketright put dup 94 /asciicircum put dup 95 /underscore put dup 96 /grave put dup 97 /a put dup 98 /b put dup 99 /c put dup 100 /d put dup 101 /e put dup 102 /f put dup 103 /g put dup 104 /h put dup 105 /i put dup 106 /j put dup 107 /k put dup 108 /l put dup 109 /m put dup 110 /n put dup 111 /o put dup 112 /p put dup 113 /q put dup 114 /r put dup 115 /s put dup 116 /t put dup 117 /u put dup 118 /v put dup 119 /w put dup 120 /x put dup 121 /y put dup 122 /z put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /asciitilde put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /quotesinglbase put dup 131 /florin put dup 132 /quotedblbase put dup 133 /ellipsis put dup 134 /dagger put dup 135 /daggerdbl put dup 136 /circumflex put dup 137 /perthousand put dup 138 /Scaron put dup 139 /guilsinglleft put dup 140 /OE put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /quoteleft put dup 146 /quoteright put dup 147 /quotedblleft put dup 148 /quotedblright put dup 149 /bullet put dup 150 /endash put dup 151 /emdash put dup 152 /tilde put dup 153 /trademark put dup 154 /scaron put dup 155 /guilsinglright put dup 156 /oe put dup 157 /.notdef put dup 158 /.notdef put dup 159 /Ydieresis put dup 160 /space put dup 161 /exclamdown put dup 162 /cent put dup 163 /sterling put dup 164 /currency put dup 165 /yen put dup 166 /brokenbar put dup 167 /section put dup 168 /dieresis put dup 169 /copyright put dup 170 /ordfeminine put dup 171 /guillemotleft put dup 172 /logicalnot put dup 173 /hyphen put dup 174 /registered put dup 175 /overscore put dup 176 /degree put dup 177 /plusminus put dup 178 /twosuperior put dup 179 /threesuperior put dup 180 /acute put dup 181 /mu1 put dup 182 /paragraph put dup 183 /middot put dup 184 /cedilla put dup 185 /onesuperior put dup 186 /ordmasculine put dup 187 /guillemotright put dup 188 /onequarter put dup 189 /onehalf put dup 190 /threequarters put dup 191 /questiondown put dup 192 /Agrave put dup 193 /Aacute put dup 194 /Acircumflex put dup 195 /Atilde put dup 196 /Adieresis put dup 197 /Aring put dup 198 /AE put dup 199 /Ccedilla put dup 200 /Egrave put dup 201 /Eacute put dup 202 /Ecircumflex put dup 203 /Edieresis put dup 204 /Igrave put dup 205 /Iacute put dup 206 /Icircumflex put dup 207 /Idieresis put dup 208 /Eth put dup 209 /Ntilde put dup 210 /Ograve put dup 211 /Oacute put dup 212 /Ocircumflex put dup 213 /Otilde put dup 214 /Odieresis put dup 215 /multiply put dup 216 /Oslash put dup 217 /Ugrave put dup 218 /Uacute put dup 219 /Ucircumflex put dup 220 /Udieresis put dup 221 /Yacute put dup 222 /Thorn put dup 223 /germandbls put dup 224 /agrave put dup 225 /aacute put dup 226 /acircumflex put dup 227 /atilde put dup 228 /adieresis put dup 229 /aring put dup 230 /ae put dup 231 /ccedilla put dup 232 /egrave put dup 233 /eacute put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B Tc gPUcOx {OqqQF4-UټXODU8o\kswKami%ޗﶥB$S/1LW~'T^<T4PX+ԯ({A34.KUĖn%*R_g!g(F4%ٸD K~ɕy8e!lcx# |< -}^^i(XlŨ3K a[y3E7Oz,߉1N6+Pj)cpS-mR\7߃Ra0bRTl,SQYKO׏C8y'߭sU5d}DҰMۭT[I[(㏭AK9%+,E B`6P( :8|NoYo>XImF;:Bŀÿ Kt,!fa"X0*Im Srߋ{8w;Ҵ+DIZy41Żp m`Z# 2;7aޗ8~$6<+p Uk!i͢m~~ I[z)*a0wmNQ ^\تw?@ċ=0}Ơ6YWUfo&|*aGѤrvʧ:q9h@) 6u%sBo$N?J6(Ah:m~\ZXݐ^NR(>^;:i~f6{'Y &'W|-}犁$$S Cp`Ӎ+Wǧ`q4{W_E&9YXs1sZQ<*`(SaD~e 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 ,E#F` &`&#HH-,E#F#a &a&#HH-,E#F` a F`&#HH-,E#F#a ` &a a&#HH-,E#F`@a f`&#HH-,E#F#a@` &a@a&#HH-, <<-, E# D# ZQX# D#Y QX# MD#Y &QX# D#Y!!-, EhD ` EFvhE`D-, C#Ce -, C#C -,F#pF>F#pFE: -,EJ#DEI#D-, E%EadPQXED!!Y-,Cc#b#B+-, EC`D-,CCe -, i@a ,b`+ d#da\XaY-,E+G#DGz-,TX CTXJIDDYY-,CXE+#DzEi #D QX+#Dz!zYY-,-,KRX!ED#E %ERXD!!YY-,/-, %EI#DEJ#DEe#E %`j #B#hj`a Ry!J@JE TX#!?#YaDRyI@ IE TX#!?#YaD-,C#C -,C#C -, C#C -, C#Ce -,C#Ce -,C#Ce -,KRXED!!Y-, %#I@` c RX#%8#%e8c8!!!!!Y-,Ei C`:-,%# `#-,%# a#-,%-, ` <<-, a <<-,++**-,CC -,>**-,5-,vK#p KE PXaY:/-,!! d#d@b-,!QX d#d b@/+Y`-,!QX d#dUb/+Y`-, d#d@b`#!-,&&&&Eh:-,&&&&Ehe:-,E# E %PX&a&`YD-,F#F`F# F`ab# #KKpE` PXa@Yh:-,3+**-,CXY-,CXY-#@/?103!%!!8 P@+  { /999?999/10&''&&'632!!!!67`,9) KgJ*JJ&J (""" """ zJzJee") """"!!""+ ]+PV =`9PPPP""""""""""""""""""""""kk4!!!!!!!!!!!!o!!!!!!!o!!!!!!!!!po==!!!!!!!!!!!!!!!!!!b!Q!?!.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!}!&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&`9_@ FF@H H2 %H2 #H2 "H2 !H2  H2 H2 H2 H2 @[H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 yH2 nH2 dH2 _H2 ]H2 ZH2 XH2 H2 H2 H2 H2 H2 H2 H2 @LH2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 \H2& & 7E@CzweaWU$"   KKSBKcKb S# QZ#BKKTB8+TXCXYY++++++++++++++++++++++++++++++++KPyAP*&+++++KSyAP*&+++++P2Ka`+++++++++++++++++++++++++++++++++++++++++++++++++++++++++EiSBKPXBYC\XBY CX`!YBp>CX;!~ +Y #B #BCX-A-A +Y#B#BCX~;! +Y#B#B endstream endobj 114 0 obj<> endobj 115 0 obj<>/FontDescriptor 114 0 R/DW 1000>> endobj 116 0 obj<>stream /CIDInit /ProcSet findresource begin 12 dict begin begincmap /CIDSystemInfo << /Registry (Adobe) /Ordering (UCS) /Supplement 0 >> def /CMapName /Adobe-Identity-UCS def /CMapType 2 def 1 begincodespacerange <0035><0085> endcodespacerange 2 beginbfrange <0035><0035><0052> <0085><0085><00a3> endbfrange endcmap CMapName currentdict /CMap defineresource pop end end endstream endobj 117 0 obj<>stream %!PS-AdobeFont-1.0: SymbolMT Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: Fri Oct 10 11:50:06 2008 % Converted from TrueType font 'SYMBOL.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 1.60) readonly def /Notice (Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved) readonly def /FullName (Symbol) readonly def /FamilyName (Symbol) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -109 def /UnderlineThickness 49 def end readonly def /FontName /SymbolMT def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {0 -220 1113 1005} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /universal put dup 35 /numbersign put dup 36 /existential put dup 37 /percent put dup 38 /ampersand put dup 39 /suchthat put dup 40 /parenleft put dup 41 /parenright put dup 42 /asteriskmath put dup 43 /plus put dup 44 /comma put dup 45 /minus put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /congruent put dup 65 /Alpha put dup 66 /Beta put dup 67 /Chi put dup 68 /Delta put dup 69 /Epsilon put dup 70 /Phi put dup 71 /Gamma put dup 72 /Eta put dup 73 /Iota put dup 74 /theta1 put dup 75 /Kappa put dup 76 /Lambda put dup 77 /Mu put dup 78 /Nu put dup 79 /Omicron put dup 80 /Pi put dup 81 /Theta put dup 82 /Rho put dup 83 /Sigma put dup 84 /Tau put dup 85 /Upsilon put dup 86 /sigma1 put dup 87 /Omega put dup 88 /Xi put dup 89 /Psi put dup 90 /Zeta put dup 91 /bracketleft put dup 92 /therefore put dup 93 /bracketright put dup 94 /perpendicular put dup 95 /underscore put dup 96 /radicalex put dup 97 /alpha put dup 98 /beta put dup 99 /chi put dup 100 /delta put dup 101 /epsilon put dup 102 /phi put dup 103 /gamma put dup 104 /eta put dup 105 /iota put dup 106 /phi1 put dup 107 /kappa put dup 108 /lambda put dup 109 /mu put dup 110 /nu put dup 111 /omicron put dup 112 /pi put dup 113 /theta put dup 114 /rho put dup 115 /sigma put dup 116 /tau put dup 117 /upsilon put dup 118 /omega1 put dup 119 /omega put dup 120 /xi put dup 121 /psi put dup 122 /zeta put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /similar put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /.notdef put dup 131 /.notdef put dup 132 /.notdef put dup 133 /.notdef put dup 134 /.notdef put dup 135 /.notdef put dup 136 /.notdef put dup 137 /.notdef put dup 138 /.notdef put dup 139 /.notdef put dup 140 /.notdef put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /.notdef put dup 146 /.notdef put dup 147 /.notdef put dup 148 /.notdef put dup 149 /.notdef put dup 150 /.notdef put dup 151 /.notdef put dup 152 /.notdef put dup 153 /.notdef put dup 154 /.notdef put dup 155 /.notdef put dup 156 /.notdef put dup 157 /.notdef put dup 158 /.notdef put dup 159 /.notdef put dup 160 /.notdef put dup 161 /Upsilon1 put dup 162 /minute put dup 163 /lessequal put dup 164 /fraction put dup 165 /infinity put dup 166 /florin put dup 167 /club put dup 168 /diamond put dup 169 /heart put dup 170 /spade put dup 171 /arrowboth put dup 172 /arrowleft put dup 173 /arrowup put dup 174 /arrowright put dup 175 /arrowdown put dup 176 /degree put dup 177 /plusminus put dup 178 /second put dup 179 /greaterequal put dup 180 /multiply put dup 181 /proportional put dup 182 /partialdiff put dup 183 /bullet put dup 184 /divide put dup 185 /notequal put dup 186 /equivalence put dup 187 /approxequal put dup 188 /ellipsis put dup 189 /arrowvertex put dup 190 /arrowhorizex put dup 191 /carriagereturn put dup 192 /aleph put dup 193 /Ifraktur put dup 194 /Rfraktur put dup 195 /weierstrass put dup 196 /circlemultiply put dup 197 /circleplus put dup 198 /emptyset put dup 199 /intersection put dup 200 /union put dup 201 /propersuperset put dup 202 /reflexsuperset put dup 203 /notsubset put dup 204 /propersubset put dup 205 /reflexsubset put dup 206 /element put dup 207 /notelement put dup 208 /angle put dup 209 /gradient put dup 210 /registerserif put dup 211 /copyrightserif put dup 212 /trademarkserif put dup 213 /product put dup 214 /radical put dup 215 /dotmath put dup 216 /logicalnot put dup 217 /logicaland put dup 218 /logicalor put dup 219 /arrowdblboth put dup 220 /arrowdblleft put dup 221 /arrowdblup put dup 222 /arrowdblright put dup 223 /arrowdbldown put dup 224 /lozenge put dup 225 /angleleft put dup 226 /registersans put dup 227 /copyrightsans put dup 228 /trademarksans put dup 229 /summation put dup 230 /parenlefttp put dup 231 /parenleftex put dup 232 /parenleftbt put dup 233 /bracketlefttp put dup 234 /bracketleftex put dup 235 /bracketleftbt put dup 236 /bracelefttp put dup 237 /braceleftmid put dup 238 /braceleftbt put dup 239 /braceex put dup 240 /.notdef put dup 241 /angleright put dup 242 /integral put dup 243 /integraltp put dup 244 /integralex put dup 245 /integralbt put dup 246 /parenrighttp put dup 247 /parenrightex put dup 248 /parenrightbt put dup 249 /bracketrighttp put dup 250 /bracketrightex put dup 251 /bracketrightbt put dup 252 /bracerighttp put dup 253 /bracerightmid put dup 254 /bracerightbt put dup 255 /.notdef put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B T=:[RXz:F.V0zjQ 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GcSoqیO5RGW!e V u3`ZHn@=V-'5ڍ<8e}O *=]K2,~$ 9{_ʷkĄ iiMUQE zJnCݎ}@-!)fW6[Vƪ/ͭEs5&GuFMM6Goq&,p"z®$u 1n$׳芄rlZ)OGV#,Y"_< +$o q#Y,=y7If?h;0T9Ƙ96oh :)]%0eO}^f~|Q40yR~Z[4uipMWdt5۟=\[Bˬ{6k6";?+9~jJ[ʭOCg/F:Pr빆D^w_ؿ  dv&p2avS)f}寺x\4YD M3G܏H esCӯ3l,z*@ ߰:U,H*C~gjOKT|+#¢ IpGƜ $WOFݪ.4)8Y$l4Зŷ-IcEth%[Y&((Yc-^!JY1Cε%kn#7!Җ !6k¸*4^s=%}kAxpY h~f_=N:h^Vz>ǼYH5\ !A\QZ_Mi[FǺÞ+#'DFwk:>^\W+ӗߣ2T )% M9'>+:%חOY/ZXifRSر`׮Ti0CJս3Ҋpfr!h- 3*ljy#q[5:-dlmj~ǧi"E7(R >b921VFhN0&:j])|+QQ[pl)q#Ï7P!˭Ӊ0ŗ`?%#k\5g-v`VLjQ4~D#dyšI)"}4$:]ȏ*eL@ohݥixҫs_lw[Qubaתk5E5r}aZs2W&__LTRcEfqnwdܺZw%9m?]ceNv{Ӛ-"%2!-xi7@o\fy>yZqGɻQ?1aLxlfU^1T;,d-aetH_{fR\boO0+/#L!Jg#{Pkw,8CFcIď±lL=f/G쩁aǁ@=A )ߎ2F)/򞻁0W WޅG' Yi%)Ӿ=vۼ96ⲧ.'TtJrRY6e. y#ojA0_3}s^ҞX5oFw$Zi0/cS**]|c˻xζs-]Az]!] s(PweUу45lgJ`B%GSm$（s;}[TL`&zD菓xr8@@v{O줵.I%F1=mM!qȱ]RƖ+ɵ}=l5 ]b-]=wri_5 "]9x@G"XRv…67TKkҔsSdb} _WÉ9# C{Z>FV^v/G%M m56<=Z̩oYaV-g3;HLzWLeojUu'"xbn\ %$jظؐ GT$˃2FuvLpf@M'X.**~֣`ZE(,>q$Y:A~.j{TǺ|3m:}EZa~ӶY{'D€p'^&d#}"d*QGv>YX咣| iBo+tt.ȤĮ~b?$1Dw"{8s,6BFn5_0(בy E-|gQ(n#׿.7=b&4$0c[tʈbVy%13Gݺ>D+ ;=ፊO?FgMOX' 3*Yj; w~}lڞ$N/DUޑ7iwJTp0< ׇW6 zw h M,Ld!Sؽ |C`%xݴ_ *yiN'"uy 5^d p w ?eh0Y>N! LF}M ߞ %E'W?n}$lg1HBs }ٕ,),rqB-AHCrf!]vx.H x"n,6\O)FG=oNXLϤ$oǤ5xiP6 cXr,xW6A1I/?@ѵ}|6DMk7\8 Li$hu/,ZPpEo_I4 0B#\Gnnqk+5SHĺfo$؉qb;~l+0vi^v(< ;nҖx hHC~3xJa昐 X[[,D|14^^NH@Z{Ӌ2QiPT0%mujB1c!>73V zeKo7VWBlL<|d`{ܮē0jQyܒصȍOptNp@eSb= nvO 3Dv`Ogfi?FujH2#F@9P  N:.J4[4#(%$mXgY@~d`ñ}V$pбSa&vѠ\U@-$L:&,GZr!aʝʹg3PVT0?+m:~تo\xkx Жj\\3>Zl ӥz :S`F G(O{ աˡ3HJBrEu70pCzOd#H6+#T<֋T4Ks^C٨CAeB"C=)?0Sge!X(><+Eg4pr\ƌz_H^zR5IcF$уUhfzo}YBӎEM^ :"% E~$6$|B^t\:T&Y]7(ou&rzOU$`.@ŪÌ#1dEi!8 uXؗvA{o o쭺8*IϿcʒ,F[bdW3PI!:$-p31/_7v2dsoF2f6-HCaj>_lU4HqFa="QT, ?|Vbd j;[&̢ %[rU_Qpܥ^&@8k%^+#IzsFK~7GϽBAnxO4D]$y;0?[")X NFʼn(5FׁK%!k6BD"c&z#aoAb( +qt.B!#`>cD>LZZP%8,b"N7PȲ:ƚo0J zvAj[ԉ8dog7XxtփmMw*έLފӲV`E*V-Ữ  /&.SQ`q2ɸxAM gV>5~"ceLMDCRBϯ/k*cqX;vD=oD4]IU%qJ> ¥7s#1Ur*)ӆaØ׻$ CocfYzalS~]E3k+vQ]2B`DoB":6V?N  l ڊӌoIcWn'tj?*:NCCI}:DrL2w!8uqI 6jw)I VrjSuX d 3h\m0 r_cσAg彜.5?A Uz4VbɎݪj@r$'bC0plDS-ȱRyvJ2v,oHAaYin~]FZvae2c'T?9 ڧ}jk5ݕ (NJ7>B\&PupȺ=΁~ Cfv By1^lbN^yϚ|nNi7C<,ɓ0P%,q94BrByÄ` 0KzG;Tz𲀶) ߧ#jShfHn tS͋!\ #[<<$9A-)kGho$D?,E]b aEiI9 ;Al^ofrׯ'`\D o FQӟ>M3`ouKhHk]bn N:7f!&Tm$cGmr_v$McnvS;$۩4Ŀov엂 VƟq>#P}#[fCE~ȕ h?Y=cZcgiGz(S'h 1B2p#{ 42h,{WUaeao¤i<͑( | K>aHc?/} MZʚ|*yNaql!oIcp87`HZyb~>@l$ʁsb1B38b P%2Pov|2ؔqeflkǨ>Am=n/rЧYע>k}+v(b .|(bz؉Z3+:@ D 3TOA %L-TiȱmpvZjfarüY8#?/}!23Gp>kwOu]Rܻ56k$9Vv𧌰y"J^#MAОXېɅq o &d҂JșZw7x6.'S7JGTBʶjj_`휱<_;жBƏ0)[ό۲ZuW2^/woC㛟'ޙ]EusN(?yn)#X],'Tִ3#" }~#k]u`WKfT7~a8o#h ׈>M9ݐ1ӌ *~q(pӎQLٔLhD H@5Aٺ4{SdZ-jhZWM7MLr#fVML8*9Dx}ȃYpK=/Vj.l:(Tt#vW3#lЁ8wǫihm&Z(pB<# pۯ߂I˝ؾQ*HJͽiPG\#r+Z/L5h/*#a<8 G(<Ң0_(K׳8f*N3p<0+s-]1"}^ZuP; 6rgbPqwb 釞 W.]J~ ;=/![_j J26U\I4m6BG`Tnhr3[[-2ffy9Ew$ Y} "KaEB `m/ 1;>H՝u NV=apnYxFoܼħdž̀u_5*\ů_cމGCg3Vk@ncEtK4TS=ZdSL<ߗx2A`l6`eRhGFߦjVCov?ѵKRNQfF>DxH!#s%trY\i)Zpd|y!' ^?C4@(=r hCarS#ɹ 20&\VaBo6 )6S Q iIE LhI:+"HzI Yq={6 kCD))jBdfjPcwW!ret2?Z;Y@J8H8r(H?RRfTG1E6+J!^HqG_Oa߅} }5W1~L\_dԭ]CHƲ b|uae6> 7D(BD{v-d'kA}shzĆh9.S^ֳ.LX92sBÔUO?)Cڰ}'UݾqsK^N􀘊#1 C,&h[X|K[19v`oYI]Ηbf?Bm=d]#wBI6=Ϭx(yJNH'-PMMHXZ%RNV|v){z!6Gp.`a{t.0*a9+wS+)ϐV63Ew` eliV}qԥvWIu@ʔ h%kNːv-cLz{z68vΝ^u<}EZBݨV$GK93Fj˅G¦~#F#?J|6hU3m6@O CVw߼H$$2s6k=G ߈rAg`Xb=Om<̭(6~"H4w30VJ\IǫkK~D$Y8?N*@ "E4tgejDۚ<~i*EX{+w8RL%hV]o)@5Hgt\Aw"cJb0rXa28zb++j `#9Kr.S)cfU)iF,^'+Am1Sjt$}^N_a󒠀s5H㘠!chwI!c26Z_#13uHW'sbS M./9inɥd|mŊ? s6x+p]^@i%_OE ۞ ȔVTu.bH ͕fF+}kOOb5ʹk}|f,1Yݔ,GuaoL%Ob4 n` {_dhA!rgmﱨJxu`%faLwqr"95[M`^#߄8u PY:&''9{5k9eP>SSUZoXtMÛpGF PpGn|˓_`?G[~\s.\A4f)$@x9Fp}#H&יYBbwx4,`њy' +Dj&!uTfzsSlĢbbba/kTjb WI;{$7{ǝ70/:`U5Zp *M%5(:)Mh|J~^ߣ5dqoۜ>KRi9mfM=uC,TftDΩTswh.xϾxW1ې'y#|/T(}M/&xR`R`1Qd1T/ \){V(WɝEh]3XRgp7RKa@Ev06S 0d{)xb*tׯ•:\`h#lCjsUqۺ5vX\!C{o u7: }" w$>{y+f>5a*Rthq #p?Ùܜ/q&Nє{p$9 *1*;rhr>kF 1l呑m!Y]%Gr $` Ӳs9%8ãNZW#P7Xup .sg\_JyYȎ0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 cleartomark endstream endobj 118 0 obj<> endobj 119 0 obj<>stream  cvt xefpgm:`headҗ 6hhea 8$hmtx7 \loca*$maxp pI prep^.cJy|]xdY'v}f| sBB99I?Zo7zLLto\S} `^B/``Y}LfK}qqLuu1=b{9ZZpqqh@=T;:9876543210/.-,+*)('&%$#"!  ,CX+!!!Y-,CX+!!!Y-,CX%!!!!Y-,CX+!!!Y-,CX+!!!Y-,CX+!!!Y-,CX+!!!Y-,NF#CD%F!M-,CXEdj#EiCd``F#D# F/!!!!Y-, C#Ce -, C#C -,F#pF>F#pFE: -,+%E%Ej@`%#D!!!-,+%E%Ej`%#D!!!-,+!!!-,+!!!-,CCe -, i@a ,b`+ d#da\XaY-,%EhTX%E%E`h %#D%#D% Eh #D%Eh`%#DY-,% Eh #D%Eh`%#D-, CX!CXE+G#DGzEi G#D QX+G#DGz!GzYYY-, E#Eh`D-,EjB-,/-,!!-,%E%Ed`j%Eja %Ej e%#D%#D!!-,Eh#Eia%Eja %Ej e%#D%#D!!-,Ed#EdadB-,%C@T%CTZX% E@aDY%CT%C@TZX% E@`DY!!!!-,KRXC%E#aD!!Y-,KRXC%E#`D!!Y-,KRXED!!Y-, %#I@` c RX#%8#%e8c8!!!!!Y-,KPXED!!Y-,%# `#-,%# a#-,%-,F#F`F# F`ab# #KKpE` PXaFY`h:-, E%FRX?!Y-, E%FPX?!Y-,CC -,KRX%%I%%Ia TX! 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C <RG<29Ap@AC6/?o /?o 7 9999PKKTBKKSB 2+KdRBKRXYKTXYKSXY++++st+ststEEha#DsEEha#DEEha#DEh#D+s+++++++++++++st++++++ssssssss+ss+s+++++st++++u++++++++++++++++++++t+st+sst+st+t+ss++st+s+++ss+++s++++s+++++++++++sttu++++++++++++++++++++++++++s+++++qEhq#Dstu++++ endstream endobj 120 0 obj<> endobj 121 0 obj<>/FontDescriptor 120 0 R/DW 1000>> endobj 122 0 obj<>stream /CIDInit /ProcSet findresource begin 12 dict begin begincmap /CIDSystemInfo << /Registry (Adobe) /Ordering (UCS) /Supplement 0 >> def /CMapName /Adobe-Identity-UCS def /CMapType 2 def 1 begincodespacerange <0003><0003> endcodespacerange 1 beginbfrange <0003><0003><00a0> endbfrange endcmap CMapName currentdict /CMap defineresource pop end end endstream endobj 123 0 obj<>stream %!PS-AdobeFont-1.0: ArialMT Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: Thu Oct 09 15:49:19 2008 % Converted from TrueType font 'ARIAL.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 2.76) readonly def /Notice (Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved) readonly def /FullName (Arial) readonly def /FamilyName (Arial) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -106 def /UnderlineThickness 73 def end readonly def /FontName /ArialMT def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {-46 -210 1000 896} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /quotedbl put dup 35 /numbersign put dup 36 /dollar put dup 37 /percent put dup 38 /ampersand put dup 39 /quotesingle put dup 40 /parenleft put dup 41 /parenright put dup 42 /asterisk put dup 43 /plus put dup 44 /comma put dup 45 /hyphen put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /at put dup 65 /A put dup 66 /B put dup 67 /C put dup 68 /D put dup 69 /E put dup 70 /F put dup 71 /G put dup 72 /H put dup 73 /I put dup 74 /J put dup 75 /K put dup 76 /L put dup 77 /M put dup 78 /N put dup 79 /O put dup 80 /P put dup 81 /Q put dup 82 /R put dup 83 /S put dup 84 /T put dup 85 /U put dup 86 /V put dup 87 /W put dup 88 /X put dup 89 /Y put dup 90 /Z put dup 91 /bracketleft put dup 92 /backslash put dup 93 /bracketright put dup 94 /asciicircum put dup 95 /underscore put dup 96 /grave put dup 97 /a put dup 98 /b put dup 99 /c put dup 100 /d put dup 101 /e put dup 102 /f put dup 103 /g put dup 104 /h put dup 105 /i put dup 106 /j put dup 107 /k put dup 108 /l put dup 109 /m put dup 110 /n put dup 111 /o put dup 112 /p put dup 113 /q put dup 114 /r put dup 115 /s put dup 116 /t put dup 117 /u put dup 118 /v put dup 119 /w put dup 120 /x put dup 121 /y put dup 122 /z put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /asciitilde put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /quotesinglbase put dup 131 /florin put dup 132 /quotedblbase put dup 133 /ellipsis put dup 134 /dagger put dup 135 /daggerdbl put dup 136 /circumflex put dup 137 /perthousand put dup 138 /Scaron put dup 139 /guilsinglleft put dup 140 /OE put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /quoteleft put dup 146 /quoteright put dup 147 /quotedblleft put dup 148 /quotedblright put dup 149 /bullet put dup 150 /endash put dup 151 /emdash put dup 152 /tilde put dup 153 /trademark put dup 154 /scaron put dup 155 /guilsinglright put dup 156 /oe put dup 157 /.notdef put dup 158 /.notdef put dup 159 /Ydieresis put dup 160 /space put dup 161 /exclamdown put dup 162 /cent put dup 163 /sterling put dup 164 /currency put dup 165 /yen put dup 166 /brokenbar put dup 167 /section put dup 168 /dieresis put dup 169 /copyright put dup 170 /ordfeminine put dup 171 /guillemotleft put dup 172 /logicalnot put dup 173 /hyphen put dup 174 /registered put dup 175 /overscore put dup 176 /degree put dup 177 /plusminus put dup 178 /twosuperior put dup 179 /threesuperior put dup 180 /acute put dup 181 /mu1 put dup 182 /paragraph put dup 183 /periodcentered put dup 184 /cedilla put dup 185 /onesuperior put dup 186 /ordmasculine put dup 187 /guillemotright put dup 188 /onequarter put dup 189 /onehalf put dup 190 /threequarters put dup 191 /questiondown put dup 192 /Agrave put dup 193 /Aacute put dup 194 /Acircumflex put dup 195 /Atilde put dup 196 /Adieresis put dup 197 /Aring put dup 198 /AE put dup 199 /Ccedilla put dup 200 /Egrave put dup 201 /Eacute put dup 202 /Ecircumflex put dup 203 /Edieresis put dup 204 /Igrave put dup 205 /Iacute put dup 206 /Icircumflex put dup 207 /Idieresis put dup 208 /Eth put dup 209 /Ntilde put dup 210 /Ograve put dup 211 /Oacute put dup 212 /Ocircumflex put dup 213 /Otilde put dup 214 /Odieresis put dup 215 /multiply put dup 216 /Oslash put dup 217 /Ugrave put dup 218 /Uacute put dup 219 /Ucircumflex put dup 220 /Udieresis put dup 221 /Yacute put dup 222 /Thorn put dup 223 /germandbls put dup 224 /agrave put dup 225 /aacute put dup 226 /acircumflex put dup 227 /atilde put dup 228 /adieresis put dup 229 /aring put dup 230 /ae put dup 231 /ccedilla put dup 232 /egrave put dup 233 /eacute put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B T13҂uGFsnA S1_ z.H@sV-umQ/ rgrVFcSctóinuk̾uA M[\b y9_ )(ib]o7PaZk=JI4wr QeR-ӐhX}Qt 1ݫja@K^ }= j"D3XU:*u?| 6&f]'(VY k?YODn7Or>TɩZfZvZ7N-N}.^1>dL,͝0n8^|0~ZPFP^̵x} Tj9th ?H2wr=\aK&cE"*X8)nXZI- Rҿ mRdokh_`V#wp; նגdRyf,jL%>lzr{,V\d6koXp a~( q;(I9zF<2(u4Z+(9%%W# )3Z+B gmMJۿ;5t2&M}wP-B*' lC7AEÐ-XaTu:RD/ ~Xmv@JO"Ⲕ!d #\8_A#~#aMzNNZ2>ieec5+#TMg]Ⴤ]p9jqe^alǣ̏:Ϯ6~O(SW™^tpTeͦVzĻ[ 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Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: Fri Oct 10 11:48:26 2008 % Converted from TrueType font 'TIMES.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 2.76) readonly def /Notice (Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved) readonly def /FullName (Times New Roman) readonly def /FamilyName (Times New Roman) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -109 def /UnderlineThickness 49 def end readonly def /FontName /TimesNewRomanPSMT def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {-77 -216 1009 877} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /quotedbl put dup 35 /numbersign put dup 36 /dollar put dup 37 /percent put dup 38 /ampersand put dup 39 /quotesingle put dup 40 /parenleft put dup 41 /parenright put dup 42 /asterisk put dup 43 /plus put dup 44 /comma put dup 45 /hyphen put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /at put dup 65 /A put dup 66 /B put dup 67 /C put dup 68 /D put dup 69 /E put dup 70 /F put dup 71 /G put dup 72 /H put dup 73 /I put dup 74 /J put dup 75 /K put dup 76 /L put dup 77 /M put dup 78 /N put dup 79 /O put dup 80 /P put dup 81 /Q put dup 82 /R put dup 83 /S put dup 84 /T put dup 85 /U put dup 86 /V put dup 87 /W put dup 88 /X put dup 89 /Y put dup 90 /Z put dup 91 /bracketleft put dup 92 /backslash put dup 93 /bracketright put dup 94 /asciicircum put dup 95 /underscore put dup 96 /grave put dup 97 /a put dup 98 /b put dup 99 /c put dup 100 /d put dup 101 /e put dup 102 /f put dup 103 /g put dup 104 /h put dup 105 /i put dup 106 /j put dup 107 /k put dup 108 /l put dup 109 /m put dup 110 /n put dup 111 /o put dup 112 /p put dup 113 /q put dup 114 /r put dup 115 /s put dup 116 /t put dup 117 /u put dup 118 /v put dup 119 /w put dup 120 /x put dup 121 /y put dup 122 /z put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /asciitilde put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /quotesinglbase put dup 131 /florin put dup 132 /quotedblbase put dup 133 /ellipsis put dup 134 /dagger put dup 135 /daggerdbl put dup 136 /circumflex put dup 137 /perthousand put dup 138 /Scaron put dup 139 /guilsinglleft put dup 140 /OE put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /quoteleft put dup 146 /quoteright put dup 147 /quotedblleft put dup 148 /quotedblright put dup 149 /bullet put dup 150 /endash put dup 151 /emdash put dup 152 /tilde put dup 153 /trademark put dup 154 /scaron put dup 155 /guilsinglright put dup 156 /oe put dup 157 /.notdef put dup 158 /.notdef put dup 159 /Ydieresis put dup 160 /space put dup 161 /exclamdown put dup 162 /cent put dup 163 /sterling put dup 164 /currency put dup 165 /yen put dup 166 /brokenbar put dup 167 /section put dup 168 /dieresis put dup 169 /copyright put dup 170 /ordfeminine put dup 171 /guillemotleft put dup 172 /logicalnot put dup 173 /hyphen put dup 174 /registered put dup 175 /overscore put dup 176 /degree put dup 177 /plusminus put dup 178 /twosuperior put dup 179 /threesuperior put dup 180 /acute put dup 181 /mu1 put dup 182 /paragraph put dup 183 /periodcentered put dup 184 /cedilla put dup 185 /onesuperior put dup 186 /ordmasculine put dup 187 /guillemotright put dup 188 /onequarter put dup 189 /onehalf put dup 190 /threequarters put dup 191 /questiondown put dup 192 /Agrave put dup 193 /Aacute put dup 194 /Acircumflex put dup 195 /Atilde put dup 196 /Adieresis put dup 197 /Aring put dup 198 /AE put dup 199 /Ccedilla put dup 200 /Egrave put dup 201 /Eacute put dup 202 /Ecircumflex put dup 203 /Edieresis put dup 204 /Igrave put dup 205 /Iacute put dup 206 /Icircumflex put dup 207 /Idieresis put dup 208 /Eth put dup 209 /Ntilde put dup 210 /Ograve put dup 211 /Oacute put dup 212 /Ocircumflex put dup 213 /Otilde put dup 214 /Odieresis put dup 215 /multiply put dup 216 /Oslash put dup 217 /Ugrave put dup 218 /Uacute put dup 219 /Ucircumflex put dup 220 /Udieresis put dup 221 /Yacute put dup 222 /Thorn put dup 223 /germandbls put dup 224 /agrave put dup 225 /aacute put dup 226 /acircumflex put dup 227 /atilde put dup 228 /adieresis put dup 229 /aring put dup 230 /ae put dup 231 /ccedilla put dup 232 /egrave put dup 233 /eacute put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B TcJ6*]h[zeKq)ƷW0jlBIf14%B[tnqNOדe{fC;1I^7^r5=[ySwF 5ZUͧ@;J7{Phx ғ*⿅΅V1lCd3Dk9+ ~Iic*x 2YC.eKgt_"t!Ztb$~iS[xdw +P7)%g9/-awT=JK/{ Q'y!kA,7 Α$?H}Om"s*5aks*HRUufn6i?kɝ=-0X%lϧQ4ݡ`rџ~D&#&:t]=.ok &DZђԺŠRq [j@3a*42K]sjϖjG_n 4Ϛ5. *Ly^w`ܮ64r/:!?u:};ߜ`dӤJY2R'wbTCI2CRNY2uD-.Y9y:2Cʸ`ͻq5dBpQŰ: TimM;f ]+ozY0,(Fh^ GirY E W| -R̵vVP ce޾'zH+1= PU~}fIa 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We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. 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Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14999 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14999 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14999 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14999 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14999 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14999 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14999 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14999 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14999 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14999 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14999 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14999 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14999 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14999 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 497 0 obj 9098 endobj 498 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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625.39001 Tm (honitonmanor@aol.com)Tj 1 0 0 1 34.05 602.56 Tm (Provider web address:)Tj 1 0 0 1 273.04999 602.56 Tm (oakdash@aol.com)Tj /T1_0 10 Tf 1 0 0 1 28.35001 583.60999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 109.98 w 32.32001 518.29999 m 564.76996 518.29999 l S 1 1 1 RG 64.32001 w 355.5 542.25 m 565.90002 542.25 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 497.54999 m 353.25 497.54999 l S 1 1 1 RG 355.5 497.54999 m 565.90002 497.54999 l S 0.95294 0.95294 0.95294 RG 31.2 474.72 m 353.25 474.72 l S 1 1 1 RG 355.5 474.72 m 565.90002 474.72 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13995 m 568.10004 486.13995 l S 28.99001 575.53998 m 568.10004 575.53998 l S 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13995 m 568.10004 486.13995 l S 28.99001 463.31 m 568.10004 463.31 l S 30.07001 576.60999 m 30.07001 462.22998 l S 354.37 576.60999 m 354.37 462.22998 l S 567.01996 576.60999 m 567.01996 462.22998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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625.39001 Tm (honitonmanor@aol.com)Tj 1 0 0 1 34.05 602.56 Tm (Provider web address:)Tj 1 0 0 1 273.04999 602.56 Tm (oakdash@aol.com)Tj /T1_0 10 Tf 1 0 0 1 28.35001 583.60999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 109.98 w 32.32001 518.29999 m 564.76996 518.29999 l S 1 1 1 RG 64.32001 w 355.5 542.25 m 565.90002 542.25 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 497.54999 m 353.25 497.54999 l S 1 1 1 RG 355.5 497.54999 m 565.90002 497.54999 l S 0.95294 0.95294 0.95294 RG 31.2 474.72 m 353.25 474.72 l S 1 1 1 RG 355.5 474.72 m 565.90002 474.72 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13992 m 568.10004 486.13992 l S 28.99001 575.53998 m 568.10004 575.53998 l S 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13992 m 568.10004 486.13992 l S 28.99001 463.31 m 568.10004 463.31 l S 30.07001 576.60999 m 30.07001 462.22998 l S 354.37 576.60999 m 354.37 462.22998 l S 567.01996 576.60999 m 567.01996 462.22998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 559.34998 Tm (Name of registered provider\(s\):)Tj 1 0 0 1 355.5 559.34998 Tm (M)Tj /TT0 12 Tf (r)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf (Howard)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf (Norman)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf (Dennis)Tj /T1_0 12 Tf (,)Tj /TT0 12 Tf ( Mrs)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf 0 -14.58002 TD (Sarah)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf (Jane)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf (Mary)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf (Dennis)Tj /T1_0 12 Tf (,)Tj /TT0 12 Tf ( Mr)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf (David)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf 0 -14.57996 TD (Malcom)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf (Baker)Tj /T1_0 12 Tf (,)Tj /TT0 12 Tf ( Mrs)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf (Angela)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf (Martha)Tj /T1_0 12 Tf ( )Tj /TT0 12 Tf 0 -14.58002 TD (Christine Baker)Tj /TT1 12 Tf (.)Tj /T1_0 12 Tf 1 0 0 1 34.05 492.78 Tm (Type of registration:)Tj 1 0 0 1 358.35001 492.78 Tm (care home)Tj 1 0 0 1 34.05 469.94998 Tm (Number of places registered:)Tj 1 0 0 1 358.35001 469.94998 Tm (22)Tj /T1_0 10 Tf 1 0 0 1 28.35001 451.00998 Tm (\240)Tj 1 0 0 1 28.35001 434.00998 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 63.99001 w 32.32001 391.69 m 564.46997 391.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 403.10001 m 567.79999 403.10001 l S 28.99001 425.92999 m 567.79999 425.92999 l S 28.99001 403.10001 m 567.79999 403.10001 l S 28.99001 359.69 m 567.79999 359.69 l S 30.07001 427.00998 m 30.07001 358.60999 l S 298.32001 404.17999 m 298.32001 358.60999 l S 566.71997 427.00998 m 566.71997 358.60999 l S BT /T1_0 12 Tf 1 0 0 1 34.05 409.75 Tm (Conditions of registration:)Tj 1 0 0 1 34.05 386.91998 Tm (Category\(ies\) :)Tj 1 0 0 1 302.30002 386.91998 Tm (Number of places \(if applicable\):)Tj 1 0 0 1 302.30002 366.34 Tm (Under 65)Tj 1 0 0 1 435.37 366.34 Tm (Over 65)Tj ET 1 1 1 RG 35.16 w 31.2 337.60999 m 297.30002 337.60999 l S 299.54999 337.60999 m 431.44998 337.60999 l S 433.70001 337.60999 m 565.60004 337.60999 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 307.48999 m 565.60004 307.48999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 318.91 m 567.79999 318.91 l S 28.99001 356.31998 m 567.79999 356.31998 l S 28.99001 318.91 m 567.79999 318.91 l S 28.99001 296.07999 m 567.79999 296.07999 l S 30.07001 357.38998 m 30.07001 295 l S 298.41998 357.38998 m 298.41998 317.82999 l S 432.56998 357.38998 m 432.56998 317.82999 l S 566.71997 357.38998 m 566.71997 295 l S BT /T1_0 12 Tf 1 0 0 1 34.05 340.13 Tm (old age, not falling within any other )Tj 1 0 0 1 34.05 325.54999 Tm (category)Tj 1 0 0 1 302.39999 340.13 Tm (0)Tj 1 0 0 1 436.54999 340.13 Tm (22)Tj 1 0 0 1 34.05 302.72 Tm (Additional conditions: )Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 281.29001 m 315.25 281.29001 l S 1 1 1 RG 317.5 281.29001 m 346.54999 281.29001 l S 348.80002 281.29001 m 377.89999 281.29001 l S 380.14999 281.29001 m 409.20001 281.29001 l S 411.44998 281.29001 m 440.54999 281.29001 l S 442.80002 281.29001 m 471.89993 281.29001 l S 474.14993 281.29001 m 503.20001 281.29001 l S 505.44998 281.29001 m 534.54999 281.29001 l S 536.79999 281.29001 m 565.90002 281.29001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 292.70001 m 568.10004 292.70001 l S 28.99001 269.87 m 568.10004 269.87 l S 30.07001 293.78 m 30.07001 268.80002 l S 316.37 293.78 m 316.37 268.80002 l S 347.66998 293.78 m 347.66998 268.80002 l S 379.01999 293.78 m 379.01999 268.80002 l S 410.31998 293.78 m 410.31998 268.80002 l S 441.66998 293.78 m 441.66998 268.80002 l S 473.01999 293.78 m 473.01999 268.80002 l S 504.31998 293.78 m 504.31998 268.80002 l S 535.66998 293.78 m 535.66998 268.80002 l S 567.01996 293.78 m 567.01996 268.80002 l S BT /T1_0 12 Tf 1 0 0 1 34.05 276.51999 Tm (Date of last inspection)Tj 1 0 0 1 328.20001 276.51999 Tm (0)Tj 1 0 0 1 359.53 276.51999 Tm (4)Tj 1 0 0 1 390.85999 276.51999 Tm (1)Tj 1 0 0 1 422.17999 276.51999 Tm (1)Tj 1 0 0 1 453.53 276.51999 Tm (2)Tj 1 0 0 1 484.85999 276.51999 Tm (0)Tj 1 0 0 1 516.17999 276.51999 Tm (0)Tj 1 0 0 1 547.52997 276.51999 Tm (8)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 258 m 565.90002 258 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 248.37 m 568.10004 248.37 l S 30.07001 249.45 m 30.07001 39.14999 l S 567.01996 249.45 m 567.01996 39.14999 l S 28.99001 267.62 m 568.10004 267.62 l S 28.99001 248.37 m 568.10004 248.37 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 268.70001 m 30.07001 247.28998 l S 567.01996 268.70001 m 567.01996 247.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 254.43999 Tm (Brief description of the )Tj 1 0 0 1 177.31 254.43999 Tm (care home)Tj 1 0 0 1 35.5 235.18999 Tm (Honiton Manor is registered to provide 24 hour nursing care for up to 22\ service users )Tj 1 0 0 1 35.5 218.19 Tm (who have needs relating to 'older people'.)Tj 1 0 0 1 35.5 201.19 Tm (\240)Tj 1 0 0 1 35.5 184.19 Tm (The two-storey home is an older style building situated on the main road\ into, and )Tj 1 0 0 1 35.5 167.19 Tm (quite close to, Honiton and the local amenities. It is on public transpo\ rt routes.)Tj 1 0 0 1 35.5 150.19 Tm (\240)Tj 1 0 0 1 35.5 133.19 Tm (There are eleven single bedrooms and five double bedrooms situated on th\ e ground )Tj 1 0 0 1 35.5 116.19 Tm (and first floors. One of the double bedrooms has an ensuite bathroom. A \ passenger lift )Tj 1 0 0 1 35.5 99.19 Tm (and a staircase link the floors.)Tj 1 0 0 1 35.5 82.19 Tm (\240)Tj 1 0 0 1 35.5 65.19 Tm (Communal space is made up of a large lounge and a dining room, both on t\ he ground )Tj 1 0 0 1 35.5 48.19 Tm (floor.)Tj ET endstream endobj 511 0 obj 4543 endobj 512 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 73.32001 w 31.2 470.10999 m 160.37999 470.10999 l S 1 1 1 RG 162.62999 470.10999 m 563.64996 470.10999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 507.89996 m 565.84998 507.89996 l S 28.99001 530.72998 m 565.84998 530.72998 l S 28.99001 507.89996 m 565.84998 507.89996 l S 28.99001 432.32999 m 565.84998 432.32999 l S 30.07001 531.79999 m 30.07001 431.25 l S 161.5 531.79999 m 161.5 431.25 l S 564.77997 531.79999 m 564.77997 431.25 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 514.53998 Tm (Name:)Tj 0 Tr 1 0 0 1 165.48 514.53998 Tm (Honiton Manor)Tj 2 Tr 1 0 0 1 34.05 491.70999 Tm (Address:)Tj 0 Tr 1 0 0 1 165.48 491.70999 Tm (Exeter Rd )Tj 1 0 0 1 165.48 474.12994 Tm (Honiton)Tj 1 0 0 1 165.48 456.54999 Tm (Devon)Tj 1 0 0 1 165.48 438.97 Tm (EX14 1AL)Tj /C2_1 10 Tf 1 0 0 1 28.35001 420.06998 Tm <0003>Tj 1 0 0 1 28.35001 403.06998 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 383.53998 m 358.94998 383.53998 l S 1 1 1 RG 361.20001 383.53998 m 565.90002 383.53998 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 394.94998 m 568.10004 394.94998 l S 28.99001 372.12 m 568.10004 372.12 l S 30.07001 396.03 m 30.07001 371.04999 l S 360.06998 396.03 m 360.06998 371.04999 l S 567.01996 396.03 m 567.01996 371.04999 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 378.76999 Tm (The quality rating for this )Tj 1 0 0 1 191.92 378.76999 Tm (care home)Tj 1 0 0 1 255.59 378.76999 Tm ( is:)Tj 0 Tr 1 0 0 1 399.30002 378.76999 Tm (zero star poor service)Tj /C2_1 10 Tf 1 0 0 1 28.35001 359.87 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 340.81 Tm (A quality rating is our assessment of how well a care home)Tj 1 0 0 1 389.13 340.81 Tm (is meeting the needs of the )Tj 1 0 0 1 28.35001 323.81 Tm (people who use it.)Tj 1 0 0 1 138.92999 323.81 Tm (\240 )Tj 1 0 0 1 147.37 323.81 Tm (We give a quality rating following a full review of the service.)Tj 1 0 0 1 517.66998 323.81 Tm (\240 )Tj 1 0 0 1 526.12 323.81 Tm (We )Tj 1 0 0 1 28.35001 306.81 Tm (call this full review a \221key\222 inspection.)Tj 1 0 0 1 28.35001 289.81 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 272.32999 m 315.25 272.32999 l S 317.5 272.32999 m 565.90002 272.32999 l S 1 1 1 RG 317.5 249.5 m 346.54999 249.5 l S 348.80002 249.5 m 377.89999 249.5 l S 380.14999 249.5 m 409.20001 249.5 l S 411.44998 249.5 m 440.54999 249.5 l S 442.80002 249.5 m 471.89996 249.5 l S 474.14996 249.5 m 503.20001 249.5 l S 505.44998 249.5 m 534.54999 249.5 l S 536.79999 249.5 m 565.90002 249.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 260.91998 m 568.10004 260.91998 l S 28.99001 283.75 m 568.10004 283.75 l S 28.99001 260.91998 m 568.10004 260.91998 l S 28.99001 238.09 m 568.10004 238.09 l S 30.07001 284.82001 m 30.07001 237.00998 l S 316.37 284.82001 m 316.37 237.00998 l S 347.66998 261.98999 m 347.66998 237.00998 l S 379.01999 261.98999 m 379.01999 237.00998 l S 410.31998 261.98999 m 410.31998 237.00998 l S 441.66998 261.98999 m 441.66998 237.00998 l S 473.01999 261.98999 m 473.01999 237.00998 l S 504.31998 261.98999 m 504.31998 237.00998 l S 535.66998 261.98999 m 535.66998 237.00998 l S 567.01996 284.82001 m 567.01996 237.00998 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 267.56 Tm (Lead inspector:)Tj 1 0 0 1 320.35001 267.56 Tm (Date:)Tj 0 Tr 1 0 0 1 34.05 244.73 Tm (Teresa Anderson)Tj 1 0 0 1 329.63 244.73 Tm (1)Tj 1 0 0 1 360.94998 244.73 Tm (9)Tj 1 0 0 1 392.28 244.73 Tm (1)Tj 1 0 0 1 423.60999 244.73 Tm (0)Tj 1 0 0 1 454.94998 244.73 Tm (2)Tj 1 0 0 1 486.28 244.73 Tm (0)Tj 1 0 0 1 517.60004 244.73 Tm (0)Tj 1 0 0 1 548.95996 244.73 Tm (9)Tj /C2_1 10 Tf 1 0 0 1 28.35001 225.83 Tm <0003>Tj 1 0 0 1 28.35001 208.83 Tm <0003>Tj /C2_0 10 Tf 1 0 0 1 297.63998 191.83 Tm <0003>Tj 1 0 0 1 297.63998 179.75998 Tm <0003>Tj 1 0 0 1 297.63998 167.7 Tm <0003>Tj ET endstream endobj 513 0 obj 5623 endobj 514 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 515 0 obj 5469 endobj 516 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 517 0 obj 9115 endobj 518 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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m 567.84998 785.63 l S 28.99001 762.79999 m 567.84998 762.79999 l S 28.99001 687.22998 m 567.84998 687.22998 l S 28.99001 664.40002 m 567.84998 664.40002 l S 28.99001 641.57001 m 567.84998 641.57001 l S 28.99001 618.73999 m 567.84998 618.73999 l S 28.99001 595.90997 m 567.84998 595.90997 l S 30.07001 786.70996 m 30.07001 594.83997 l S 269.07001 786.70996 m 269.07001 594.83997 l S 566.76996 786.70996 m 566.76996 594.83997 l S BT /T1_0 12 Tf 1 0 0 1 34.05 769.45001 Tm (Name of care home:)Tj 1 0 0 1 273.04999 769.45001 Tm (Honiton Manor)Tj 1 0 0 1 34.05 746.62 Tm (Address:)Tj 1 0 0 1 273.04999 746.62 Tm (Exeter Rd )Tj 1 0 0 1 273.04999 729.03998 Tm (Honiton)Tj 1 0 0 1 273.04999 711.45996 Tm (Devon)Tj 1 0 0 1 273.04999 693.88 Tm (EX14 1AL)Tj 1 0 0 1 34.05 671.04999 Tm (Telephone number:)Tj 1 0 0 1 273.04999 671.04999 Tm (0140445204)Tj 1 0 0 1 34.05 648.21997 Tm (Fax number:)Tj 1 0 0 1 273.04999 648.21997 Tm (0140445324)Tj 1 0 0 1 34.05 625.39001 Tm (Email address:)Tj 1 0 0 1 273.04999 625.39001 Tm (honitonmanor@aol.com)Tj 1 0 0 1 34.05 602.56 Tm (Provider web address:)Tj 1 0 0 1 273.04999 602.56 Tm (oakdash@aol.com)Tj /T1_0 10 Tf 1 0 0 1 28.35001 583.60999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 109.98 w 32.32001 518.29999 m 564.76996 518.29999 l S 1 1 1 RG 64.32001 w 355.5 542.25 m 565.90002 542.25 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 497.54999 m 353.25 497.54999 l S 1 1 1 RG 355.5 497.54999 m 565.90002 497.54999 l S 0.95294 0.95294 0.95294 RG 31.2 474.72 m 353.25 474.72 l S 1 1 1 RG 355.5 474.72 m 565.90002 474.72 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13989 m 568.10004 486.13989 l S 28.99001 575.53998 m 568.10004 575.53998 l S 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13989 m 568.10004 486.13989 l S 28.99001 463.31 m 568.10004 463.31 l S 30.07001 576.60999 m 30.07001 462.22998 l S 354.37 576.60999 m 354.37 462.22998 l S 567.01996 576.60999 m 567.01996 462.22998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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0.95294 RG 17 w 31.2 258 m 565.90002 258 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 248.37 m 568.10004 248.37 l S 30.07001 249.45 m 30.07001 39.14999 l S 567.01996 249.45 m 567.01996 39.14999 l S 28.99001 267.62 m 568.10004 267.62 l S 28.99001 248.37 m 568.10004 248.37 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 268.70001 m 30.07001 247.28998 l S 567.01996 268.70001 m 567.01996 247.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 254.43999 Tm (Brief description of the )Tj 1 0 0 1 177.31 254.43999 Tm (care home)Tj 1 0 0 1 35.5 235.18999 Tm (Honiton Manor is registered to provide 24 hour nursing care for up to 22\ service users )Tj 1 0 0 1 35.5 218.19 Tm (who have needs relating to 'older people'.)Tj 1 0 0 1 35.5 201.19 Tm (\240)Tj 1 0 0 1 35.5 184.19 Tm (The two-storey home is an older style building situated on the main road\ into, and )Tj 1 0 0 1 35.5 167.19 Tm (quite close to, Honiton and the local amenities. It is on public transpo\ rt routes.)Tj 1 0 0 1 35.5 150.19 Tm (\240)Tj 1 0 0 1 35.5 133.19 Tm (There are eleven single bedrooms and five double bedrooms situated on th\ e ground )Tj 1 0 0 1 35.5 116.19 Tm (and first floors. One of the double bedrooms has an ensuite bathroom. A \ passenger lift )Tj 1 0 0 1 35.5 99.19 Tm (and a staircase link the floors.)Tj 1 0 0 1 35.5 82.19 Tm (\240)Tj 1 0 0 1 35.5 65.19 Tm (Communal space is made up of a large lounge and a dining room, both on t\ he ground )Tj 1 0 0 1 35.5 48.19 Tm (floor.)Tj ET endstream endobj 519 0 obj 1404 endobj 520 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 689.07996 l S 567.01996 795.47998 m 567.01996 689.07996 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 690.14996 m 568.10004 690.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (\240)Tj 1 0 0 1 33.25 766.46997 Tm (Outside there is access to a seating area and parking.)Tj 1 0 0 1 33.25 749.46997 Tm (\240)Tj 1 0 0 1 33.25 732.46997 Tm (Current charges are \243515.00 - \243675.00 per week. Charges do not inc\ lude items such )Tj 1 0 0 1 33.25 715.46997 Tm (as newspapers, toiletries, taxis etc.)Tj 1 0 0 1 33.25 698.46997 Tm (\240)Tj ET endstream endobj 521 0 obj 3597 endobj 522 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28999 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50999 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (This unannounced key inspection was due to be undertaken in November 200\ 9. It was )Tj 1 0 0 1 35.17 240.90001 Tm (bought forward as we had received some concerns about the quality of car\ e that )Tj 1 0 0 1 35.17 226.31999 Tm (people living here are receiving.)Tj 1 0 0 1 35.17 211.73999 Tm (\240)Tj 1 0 0 1 35.17 197.14999 Tm (During this visit we \(the commission\) spoke with or observed the major\ ity of people )Tj 1 0 0 1 35.17 182.56999 Tm (living here. We could not speak with some people because they have commu\ nication )Tj 1 0 0 1 35.17 167.98999 Tm (difficulties such as dementia. We looked closely at the care, services a\ nd )Tj 1 0 0 1 35.17 153.41 Tm (accommodation offered to four people living here. This is called case tr\ acking and helps )Tj 1 0 0 1 35.17 138.84 Tm (us to make a judgment about the standard of care overall, and helps us t\ o understand )Tj 1 0 0 1 35.17 124.25 Tm (the experiences of people who live here.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (We looked at the care and attention given by staff to these people and w\ e looked at )Tj 1 0 0 1 35.17 80.50999 Tm (their assessments and at their care planning records. We looked at the e\ nvironment in )Tj 1 0 0 1 35.17 65.93001 Tm (relation to their needs and how their health and personal care needs are\ met. We also )Tj ET endstream endobj 523 0 obj 2315 endobj 524 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 280.01999 w 32.32001 672.51996 m 566.71997 672.51996 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 531.38 m 568.91998 531.38 l S 31.2 814.72998 m 31.2 530.31 l S 567.84998 814.72998 m 567.84998 530.31 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (spoke with visitors to the home, with staff and with the manager and one\ of the )Tj 1 0 0 1 32.92 788.13995 Tm (owners. We visited the majority of bedrooms and saw all service and comm\ unal areas )Tj 1 0 0 1 32.92 773.56 Tm (of the home.)Tj 1 0 0 1 32.92 758.97998 Tm (\240)Tj 1 0 0 1 32.92 744.40002 Tm (We looked at records relating to accidents and incidents, staff training\ , staff )Tj 1 0 0 1 32.92 729.82001 Tm (recruitment, medication and at some policies.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (Prior to the inspection the owners sent us their Annual Quality Assuranc\ e Assessment )Tj 1 0 0 1 32.92 686.07996 Tm (\(AQAA\) which gave us information about the home and it's management an\ d about the )Tj 1 0 0 1 32.92 671.5 Tm (needs of people living here. This document asks for evidence in relation\ to what the )Tj 1 0 0 1 32.92 656.91998 Tm (home does well and what they think they can improve upon.)Tj 1 0 0 1 32.92 642.33997 Tm (\240)Tj 1 0 0 1 32.92 627.76001 Tm (In addition, we sent surveys to 8 people living here and 3 were returned\ . We sent 8 )Tj 1 0 0 1 32.92 613.17999 Tm (surveys to staff and 3 were returned. We sent 4 surveys to health and so\ cial care )Tj 1 0 0 1 32.92 598.60004 Tm (professionals and all were returned. Feedback and comments are included \ in the )Tj 1 0 0 1 32.92 584.01996 Tm (report.)Tj 1 0 0 1 32.92 569.44 Tm (\240)Tj 1 0 0 1 32.92 554.85999 Tm (During this inspection evidence was taken under the Police and Criminal \ Evidence Act )Tj 1 0 0 1 32.92 540.27997 Tm (and this has been considered under our enforcement procedures.)Tj ET endstream endobj 525 0 obj 6453 endobj 526 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 64.32001 w 32.32001 741.65997 m 566.71997 741.65997 l S 20.58 w 32.7 696.95996 m 569.34998 696.95996 l S 93.48 w 33.82001 637.67999 m 568.21997 637.67999 l S 20.58 w 33.45 578.40002 m 570.10004 578.40002 l S 501.84 w 34.57001 314.94998 m 568.96997 314.94998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 708.38 m 568.91998 708.38 l S 31.2 776.02997 m 31.2 707.29999 l S 31.2 708.38 m 569.34998 708.38 l S 32.7 685.54999 m 569.34998 685.54999 l S 31.62 685.54999 m 570.41998 685.54999 l S 31.62 589.82001 m 570.41998 589.82001 l S 33.45 566.98999 m 570.10004 566.98999 l S 33.45 589.82001 m 570.10004 589.82001 l S 32.37 566.98999 m 571.16998 566.98999 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 686.63 m 32.7 588.73999 l S 33.45 568.07001 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 707.29999 l S 569.34998 686.63 m 569.34998 588.73999 l S 570.10004 568.07001 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (This home is warm, clean and comfortable. Staff are described as nice an\ d caring and )Tj 1 0 0 1 35.17 744.17999 Tm (as doing their best. The home has a lot of nursing equipment such as adj\ ustable beds )Tj 1 0 0 1 35.17 729.60004 Tm (and pressure relieving mattresses. People really enjoy the food served h\ ere which is )Tj 1 0 0 1 35.17 715.01996 Tm (nutritious and offers variety. )Tj /T1_0 10 Tf 1 0 0 1 568.96997 740.10999 Tm (\240)Tj 1 0 0 1 31.2 694.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 692.19 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 695.40997 Tm (\240)Tj 1 0 0 1 31.2 636.13 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 669.35999 Tm (Since the last inspection the programme of redecoration has continued. W\ e saw that a )Tj 1 0 0 1 36.67 654.77997 Tm (window was being replaced and that the front door is now secured with a \ key pad type )Tj 1 0 0 1 36.67 640.20001 Tm (lock.)Tj 1 0 0 1 36.67 625.62 Tm (The home has employed a part time activities co-ordinator and this perso\ n's efforts are )Tj 1 0 0 1 36.67 611.03998 Tm (having an impact for some people.)Tj 1 0 0 1 36.67 596.45996 Tm (The Requirement made at the last inspection in relation to medicines has\ been met. )Tj /T1_0 10 Tf 1 0 0 1 570.46997 636.13 Tm (\240)Tj 1 0 0 1 31.2 576.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 573.63 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 313.38998 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 550.79999 Tm (This home does not have a registered manager and is not being sufficient\ ly well )Tj 1 0 0 1 37.42 536.21997 Tm (managed. This has resulted in people's health and welfare needs not alwa\ ys being )Tj 1 0 0 1 37.42 521.64001 Tm (assessed or met. The care planning and communicating systems in place ar\ e not )Tj 1 0 0 1 37.42 507.06 Tm (sufficiently robust to ensure that care staff have the information they \ need about )Tj 1 0 0 1 37.42 492.47998 Tm (people's care needs and how these should be met.)Tj 1 0 0 1 37.42 477.89999 Tm (\240)Tj 1 0 0 1 37.42 463.31998 Tm (Staff are well intentioned but are not always on duty in sufficient numb\ ers, and do not )Tj 1 0 0 1 37.42 448.73999 Tm (always have the support they need, to meet people's needs. On one night \ there was )Tj 1 0 0 1 37.42 434.16 Tm (not a waking Registered Nurse on duty. Staff are not recruited in a robu\ st way and this )Tj 1 0 0 1 37.42 419.57999 Tm (means that people are at risk of being cared for by inappropriate staff.\ )Tj 1 0 0 1 37.42 405 Tm (\240)Tj 1 0 0 1 37.42 390.41998 Tm (People are not always treated with dignity and their rights to make choi\ ces or to be )Tj 1 0 0 1 37.42 375.84 Tm (engaged and sociable are not always supported. Some people's sense of se\ lf and )Tj 1 0 0 1 37.42 361.25998 Tm (personal identity is in danger of being eroded by a system that is not a\ lways person )Tj 1 0 0 1 37.42 346.67999 Tm (centred and is sometimes institutionalised.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Complaints have been made to the commission by some people. They complai\ n that )Tj 1 0 0 1 37.42 302.94 Tm (the home is not well managed and the quality of care has declined. These\ concerns are )Tj 1 0 0 1 37.42 288.35999 Tm (being investigated by the local safeguarding team. This is the second sa\ feguarding )Tj 1 0 0 1 37.42 273.78 Tm (alert that has been made since the last inspection. Whilst this investig\ ation is ongoing, )Tj 1 0 0 1 37.42 259.20001 Tm (admissions to this home via health or social care services have been sus\ pended by )Tj 1 0 0 1 37.42 244.62 Tm (Adult and Community Services.)Tj 1 0 0 1 37.42 230.03999 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Staff training is not up to date and some specialist training is being d\ esignated to )Tj 1 0 0 1 37.42 200.87999 Tm (people who are not qualified or experienced to carry this out.)Tj 1 0 0 1 37.42 186.3 Tm (\240)Tj 1 0 0 1 37.42 171.72 Tm (Some working practices and systems are not ensuring people's safety. Thi\ s includes )Tj 1 0 0 1 37.42 157.14 Tm (moving and handling people, ensuring windows are restricted to prevent a\ ccidental )Tj 1 0 0 1 37.42 142.56 Tm (falls, the maintenance of equipment and risk assessments and actions in \ relation to the )Tj 1 0 0 1 37.42 127.98 Tm (use of restraint. Systems are not robust enough to ensure that it is cle\ ar which staff )Tj 1 0 0 1 37.42 113.40001 Tm (have received mandatory training and which have not. The system for reco\ rding and )Tj 1 0 0 1 37.42 98.82001 Tm (monitoring accidents and incidents is not being used to help prevent fur\ ther accidents.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (The commission have not been kept informed in relation to all incidents,\ accidents and )Tj ET endstream endobj 527 0 obj 2243 endobj 528 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 148.8 w 34.57001 738.13 m 568.96997 738.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 662.60004 m 571.16998 662.60004 l S 33.45 814.72998 m 33.45 661.52997 l S 570.10004 814.72998 m 570.10004 661.52997 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (deaths in the home, as we should be so that we can monitor this type of \ activity in the )Tj 1 0 0 1 35.17 788.13995 Tm (home.)Tj 1 0 0 1 35.17 773.56 Tm (\240)Tj 1 0 0 1 35.17 758.97998 Tm (Statutory Requirement Notices have been issued to the registered owners \ of this )Tj 1 0 0 1 35.17 744.40002 Tm (service. These Notices inform the providers that they have failed to com\ ply with the )Tj 1 0 0 1 35.17 729.82001 Tm (Care Home Regulations 2001 in relation to planning people's care and in \ relation to )Tj 1 0 0 1 35.17 715.23999 Tm (meeting people's health and welfare needs. The Statutory Requirement Not\ ices tell the )Tj 1 0 0 1 35.17 700.65997 Tm (providers what they must do and gives them dates by when the failures id\ entified must )Tj 1 0 0 1 35.17 686.07996 Tm (be addressed.)Tj 1 0 0 1 35.17 671.5 Tm (\240)Tj 1 0 0 1 28.35001 648.03998 Tm (\240)Tj 1 0 0 1 28.35001 628.04999 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 628.04999 Tm (care home)Tj 1 0 0 1 480.03998 628.04999 Tm ( is taking )Tj 1 0 0 1 28.35001 610.54999 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 590.56 Tm (\240)Tj 1 0 0 1 28.35001 570.56 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 570.56 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 550.56 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 550.56 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 530.57001 Tm (order line 0870 240 7535.)Tj ET endstream endobj 529 0 obj 1804 endobj 530 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 531 0 obj 5905 endobj 532 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16998 l S 564.77997 716.82996 m 564.77997 506.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (Some people move into this home without having their needs fully assesse\ d and )Tj 1 0 0 1 36.62 341.25 Tm (without agreement from the funding authority. This means that people can\ not be sure )Tj 1 0 0 1 36.62 323.75998 Tm (that their needs will be met in an appropriate way or that they will be \ staying in this )Tj 1 0 0 1 36.62 306.25998 Tm (home. )Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95999 m 565.87 249.95999 l S 32.35001 251.03999 m 32.35001 78.70001 l S 564.78998 251.03999 m 564.78998 78.70001 l S 32.35001 249.95999 m 564.78998 249.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (In surveys two out of three people who live here told us that they had t\ he information )Tj 1 0 0 1 36.57001 216.78 Tm (they needed to decide if this was the home for them. In addition, two ou\ t of three )Tj 1 0 0 1 36.57001 199.28 Tm (health care professionals say that the home's assessment arrangements us\ ually )Tj 1 0 0 1 36.57001 181.78999 Tm (ensure that accurate information is gathered and that the right service \ is planned for )Tj 1 0 0 1 36.57001 164.28999 Tm (people. One health care professional told us that this always happens.)Tj 1 0 0 1 36.57001 146.78999 Tm (\240)Tj 1 0 0 1 36.57001 129.3 Tm (We were told that the home had admitted two people to this home without \ an )Tj 1 0 0 1 36.57001 111.8 Tm (assessment by and without the agreement of the funding authority. When w\ e looked )Tj 1 0 0 1 36.57001 94.31 Tm (at records we found these people had been admitted from a residential ho\ me owned )Tj ET endstream endobj 533 0 obj 2644 endobj 534 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 336.30002 w 34.60001 643.26001 m 562.53998 643.26001 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 314.92999 w 33.47 631.44 m 563.65997 631.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 471.78 l S 564.78998 791.10999 m 564.78998 471.78 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 472.85999 m 565.87 472.85999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (by the owners of this home.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We spoke with staff who told us that one of these people had moved here \ because )Tj 1 0 0 1 34.32001 726.60999 Tm (they have nursing needs and therefore need their care to be planned and \ delivered by )Tj 1 0 0 1 34.32001 709.10999 Tm (registered nurses.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We looked at the records of one of these people. We found that an assess\ ment of their )Tj 1 0 0 1 34.32001 656.63 Tm (nursing needs had not taken place prior to their admission, or since the\ ir admission. )Tj 1 0 0 1 34.32001 639.13 Tm (We found that all assessments in their records have been carried out in \ the home they )Tj 1 0 0 1 34.32001 621.63 Tm (used to live in.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (We could not speak with this person about their feelings about the move \ as they have )Tj 1 0 0 1 34.32001 569.14996 Tm (communication difficulties. We spoke with the relative of another person\ living here. )Tj 1 0 0 1 34.32001 551.64996 Tm (They told us that they had looked around the home and at the bedroom the\ person )Tj 1 0 0 1 34.32001 534.14996 Tm (would move into. They were able to ask questions about the home before d\ eciding this )Tj 1 0 0 1 34.32001 516.65997 Tm (was the right home. However, we noted that this person's care record did\ not contain )Tj 1 0 0 1 34.32001 499.16 Tm (pre admission information from health and social care professionals as i\ t should.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj ET endstream endobj 535 0 obj 5782 endobj 536 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 403.25 m 562.53998 403.25 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 119.35001 w 33.47 392 m 563.65997 392 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 330.12 l S 564.78998 453.88 m 564.78998 330.12 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 331.20001 m 565.87 331.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (Peoples' medicines are safely managed. However, some people are being pu\ t at risk )Tj 1 0 0 1 36.62 375.25 Tm (because their health and welfare needs are not being met. People do not \ have their )Tj 1 0 0 1 36.62 357.75998 Tm (care planned in a person centred way that treats them as individuals and\ are not )Tj 1 0 0 1 36.62 340.25998 Tm (always treated with dignity. )Tj 1 0 0 1 28.35001 315.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.3 w 34.60001 193.67999 m 562.53998 193.67999 l S 1 1 1 RG 22.5 w 32.35001 296.32999 m 564.78998 296.32999 l S 201.92999 w 33.47 181.87 m 563.65997 181.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 283.95999 m 565.87 283.95999 l S 32.35001 285.04001 m 32.35001 78.70001 l S 564.78998 285.04001 m 564.78998 78.70001 l S 32.35001 283.95999 m 564.78998 283.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.26999 Tm (In surveys people living here told us they usually get the care and supp\ ort they need )Tj 1 0 0 1 36.57001 250.78 Tm (and that they always or usually get the medical support they need.)Tj 1 0 0 1 36.57001 233.28 Tm (\240)Tj 1 0 0 1 36.57001 215.78999 Tm (Two health care professionals told us that people's health care needs ar\ e always )Tj 1 0 0 1 36.57001 198.28999 Tm (properly monitored and one told us this usually happens. Two also said t\ hat the staff )Tj 1 0 0 1 36.57001 180.78999 Tm (at the home seek advice and act on it to improve well being, and one sai\ d that this )Tj 1 0 0 1 36.57001 163.3 Tm (sometimes happened. Comments from health care professionals include that\ staff act )Tj 1 0 0 1 36.57001 145.8 Tm (promptly to get medical help for people who need it and that some people\ have )Tj 1 0 0 1 36.57001 128.31 Tm (blossomed since living here.)Tj 1 0 0 1 36.57001 110.81 Tm (\240)Tj 1 0 0 1 36.57001 93.31 Tm (We looked in depth at the care plans of four people living here. We also\ looked at )Tj ET endstream endobj 537 0 obj 5378 endobj 538 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (some others. We found that each person has a plan of care and that these\ contain a )Tj 1 0 0 1 34.32001 761.60004 Tm (large number and range of documents relating to care needs. However, the\ se )Tj 1 0 0 1 34.32001 744.10999 Tm (documents were not person centred, are sometimes contradictory and do no\ t always )Tj 1 0 0 1 34.32001 726.60999 Tm (provide care staff with the detailed information that they need to meet \ people's needs.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (For example one person that we case tracked has been admitted from the o\ wners' )Tj 1 0 0 1 34.32001 674.12 Tm (residential home. This person's care plan is the care plan from that hom\ e. Staff told us )Tj 1 0 0 1 34.32001 656.63 Tm (that the reason this person was admitted to this home was because staff \ believe that )Tj 1 0 0 1 34.32001 639.13 Tm (they need the 24 hour care of nurses. However, nurses have not devised a\ care plan )Tj 1 0 0 1 34.32001 621.63 Tm (as to how this person's nursing needs are to be met. In addition, inform\ ation recorded )Tj 1 0 0 1 34.32001 604.14001 Tm (in the daily notes from the residential home has not been followed up. B\ efore being )Tj 1 0 0 1 34.32001 586.64001 Tm (admitted to this home, it was recorded that this person has a urinary ca\ theter, is )Tj 1 0 0 1 34.32001 569.14996 Tm (prone to urinary tract infections and needs encouragement to drink. Two \ days before )Tj 1 0 0 1 34.32001 551.64996 Tm (being admitted it is recorded that this person had very strong and dark \ urine which )Tj 1 0 0 1 34.32001 534.14996 Tm (means this person may not be drinking enough fluid. This person has live\ d in this care )Tj 1 0 0 1 34.32001 516.65997 Tm (home for approximately 6 weeks and the care notes have not mentioned thi\ s person's )Tj 1 0 0 1 34.32001 499.16 Tm (urine. We asked staff about this and they told us that the night staff e\ mpty the )Tj 1 0 0 1 34.32001 481.66998 Tm (catheter bag and that they didn't know how much urine this person passed\ or what )Tj 1 0 0 1 34.32001 464.16998 Tm (colour it is.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked to see how much this person drinks in a day because the reside\ ntial care )Tj 1 0 0 1 34.32001 411.67999 Tm (home instructions state that they should be encouraged to drink to preve\ nt urinary )Tj 1 0 0 1 34.32001 394.19 Tm (tract infections. We saw records that show this person drinks between 20\ 0mls and )Tj 1 0 0 1 34.32001 376.69 Tm (1050mls in a day. The records do not contain instructions about how much\ this person )Tj 1 0 0 1 34.32001 359.19 Tm (should drink in a day. We asked carers how much this person should drink\ to keep )Tj 1 0 0 1 34.32001 341.70001 Tm (them healthy and they thought that this would be about 1000mls. We asked\ carers if )Tj 1 0 0 1 34.32001 324.20001 Tm (they knew how much this person had drunk in the past days and they said \ they did )Tj 1 0 0 1 34.32001 306.70999 Tm (not because the nurse totals up the amount drunk. A nurse has reviewed t\ he records )Tj 1 0 0 1 34.32001 289.20999 Tm (kept about this person and the amount they have drunk. They record, in d\ ifferent )Tj 1 0 0 1 34.32001 271.70999 Tm (places in the care plan, that they have drunk a fair amount, small amoun\ t and a good )Tj 1 0 0 1 34.32001 254.22 Tm (amount. However, these reviews do not appear to have taken into account \ the days )Tj 1 0 0 1 34.32001 236.72 Tm (when this person has only drunk 200mls, 350mls and 400mls. We have calcu\ lated )Tj 1 0 0 1 34.32001 219.23 Tm (that this person, according to their weight, should have at least 1880ml\ s to drink each )Tj 1 0 0 1 34.32001 201.73 Tm (day. We spoke with the temporary manager about how much people should dr\ ink. She )Tj 1 0 0 1 34.32001 184.23 Tm (told us she knows there is a calculation to work this out, but does not \ know what it is. )Tj 1 0 0 1 34.32001 166.73999 Tm (We also noted that records show that this person does not have a drink b\ etween 6pm )Tj 1 0 0 1 34.32001 149.23999 Tm (and 8 or 9am. This is a very long time for someone who has a catheter an\ d is prone to )Tj 1 0 0 1 34.32001 131.75 Tm (urinary tract infections.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (We observed this person on the day of this inspection. They had numerous\ drinks put )Tj ET endstream endobj 539 0 obj 5195 endobj 540 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (in front of them by members of staff. No encouragement to drink was give\ n by staff, )Tj 1 0 0 1 34.32001 761.60004 Tm (but was given by their wife. we would estimate that this person drank ap\ proximately )Tj 1 0 0 1 34.32001 744.10999 Tm (50mls between 10am and 1pm.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We also saw that other people do not have enough to drink.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We saw in care plans that people are assessed to see if they are at risk\ of developing )Tj 1 0 0 1 34.32001 656.63 Tm (pressure sores. We saw that people we had case tracked are at risk. Thes\ e people are )Tj 1 0 0 1 34.32001 639.13 Tm (cared for on pressure relieving mattresses and cushions as is good pract\ ice. Some )Tj 1 0 0 1 34.32001 621.63 Tm (people are also nursed on adjustable beds which is also good practice. W\ e were told )Tj 1 0 0 1 34.32001 604.14001 Tm (that one person has developed a pressure sore since coming to live here \ and that one )Tj 1 0 0 1 34.32001 586.64001 Tm (person came to the home having already developed a pressure sore. We loo\ ked at )Tj 1 0 0 1 34.32001 569.14996 Tm (some pressure relieving equipment. We found one mattress had been set to\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (maximum pressure indicating that the person using this mattress is heavy\ . When we )Tj 1 0 0 1 34.32001 534.14996 Tm (looked in care records we found that this person is very light. We asked\ staff how they )Tj 1 0 0 1 34.32001 516.65997 Tm (work out the pressure that the mattress should be set to. One person sai\ d they did )Tj 1 0 0 1 34.32001 499.16 Tm (not know, another said the person setting it up does it. We looked in ca\ re plans, in )Tj 1 0 0 1 34.32001 481.66998 Tm (people's bedrooms and on the mattress motors to see if staff have access\ to )Tj 1 0 0 1 34.32001 464.16998 Tm (instructions about the pressure each mattress should be set at. We did n\ ot find any )Tj 1 0 0 1 34.32001 446.66998 Tm (instructions.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We saw in care plans that some people are at risk of malnutrition. One p\ erson we case )Tj 1 0 0 1 34.32001 394.19 Tm (tracked is losing weight. The GP has been informed. However, the recomme\ ndations )Tj 1 0 0 1 34.32001 376.69 Tm (made by the specialist nutritional tool used \(MUST\) have not been foll\ owed. According )Tj 1 0 0 1 34.32001 359.19 Tm (to this person's level of risk they should be having specific drinks to \ supplement their )Tj 1 0 0 1 34.32001 341.70001 Tm (calorie intake. Records show that these are given intermittently and not\ routinely. We )Tj 1 0 0 1 34.32001 324.20001 Tm (asked staff if this person has supplement drinks and they said no.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We noted in another person's records that they had been having loose bow\ el motions )Tj 1 0 0 1 34.32001 271.70999 Tm (and saw and heard from a relative that they had been off their food. Rec\ ords also )Tj 1 0 0 1 34.32001 254.22 Tm (show that this person has been what is described as 'grumpy'. This perso\ n has been )Tj 1 0 0 1 34.32001 236.72 Tm (weighed weekly. Although the most recent weight shows a weight gain, the\ general )Tj 1 0 0 1 34.32001 219.23 Tm (trend is that this person is losing weight. There was no record to show \ that this is )Tj 1 0 0 1 34.32001 201.73 Tm (being addressed. Staff are not keeping records of what this person eats \ and drinks. A )Tj 1 0 0 1 34.32001 184.23 Tm (nurse had recorded that they had reviewed this care plan but had not tak\ en any action )Tj 1 0 0 1 34.32001 166.73999 Tm (to address these health issues. This means that this person's health is \ not being )Tj 1 0 0 1 34.32001 149.23999 Tm (monitored appropriately and might result in a delay in appropriate actio\ n being taken.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (Prior to this inspection, the owners provided us with an updated improve\ ment plan in )Tj 1 0 0 1 34.32001 96.75 Tm (relation to requirements made at the last inspection about meeting peopl\ e's nutritional )Tj ET endstream endobj 541 0 obj 5376 endobj 542 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs. This told us that the completion of the nutritional risk assessme\ nt tool \(MUST\) )Tj 1 0 0 1 34.32001 761.60004 Tm (and for taking action if risk is identified has been designated to the c\ atering manager. )Tj 1 0 0 1 34.32001 744.10999 Tm (This person, along with other staff in the home, has received training i\ n relation to )Tj 1 0 0 1 34.32001 726.60999 Tm (nutrition from a company that supplies nutritional supplements. However,\ this does )Tj 1 0 0 1 34.32001 709.10999 Tm (not qualify them to carry out these assessments or to determine the acti\ ons that )Tj 1 0 0 1 34.32001 691.62 Tm (should be taken.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (Another care plan recorded that one person stays in bed all day and does\ not get )Tj 1 0 0 1 34.32001 639.13 Tm (dressed. It states the reason for this as them being immobile and having\ contractures )Tj 1 0 0 1 34.32001 621.63 Tm (of their legs. Records do not include evidence that consideration has be\ en given, or )Tj 1 0 0 1 34.32001 604.14001 Tm (that actions have been taken, to make arrangements or find moving and ha\ ndling )Tj 1 0 0 1 34.32001 586.64001 Tm (equipment that might allow this person to move out of their bed.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We looked at other records relating to people with dementia. Care plans \ state for )Tj 1 0 0 1 34.32001 534.14996 Tm (example, that some people have a poor mental state and reduced powers of\ )Tj 1 0 0 1 34.32001 516.65997 Tm (comprehension. However, care plans do not provide a plan as to how these\ people's )Tj 1 0 0 1 34.32001 499.16 Tm (mental health and welfare needs are to be addressed or met. In addition,\ it has been )Tj 1 0 0 1 34.32001 481.66998 Tm (agreed on three people's behalf, who are described as confused or having\ dementia, )Tj 1 0 0 1 34.32001 464.16998 Tm (that they would like to get them up as early as 6am. One of these people\ has an )Tj 1 0 0 1 34.32001 446.66998 Tm (illness the symptoms of which include stiffness, especially in the morni\ ng and fatigue. )Tj 1 0 0 1 34.32001 429.17999 Tm (These symptoms do not seem to have been considered in the decision to ge\ t them up )Tj 1 0 0 1 34.32001 411.67999 Tm (early.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We observed that one person is at high risk of choking as they have diff\ iculty )Tj 1 0 0 1 34.32001 359.19 Tm (swallowing. This person was referred to the Speech and Language Therapis\ t \(SALT\) )Tj 1 0 0 1 34.32001 341.70001 Tm (some time ago. However, a visiting health care professional observed tha\ t staff were )Tj 1 0 0 1 34.32001 324.20001 Tm (not following the guidance given by the SALT. They asked this specialist\ to visit again. )Tj 1 0 0 1 34.32001 306.70999 Tm (Instructions were left for staff to follow as to how this person is to b\ e supported to )Tj 1 0 0 1 34.32001 289.20999 Tm (eat. We saw that some of this guidance is being put into practice. Howev\ er, we also )Tj 1 0 0 1 34.32001 271.70999 Tm (saw that some is not. For example, we saw that nurses saw a visitor offe\ ring this )Tj 1 0 0 1 34.32001 254.22 Tm (person a chocolate covered wafer. They did not explain to the visitor th\ at this might )Tj 1 0 0 1 34.32001 236.72 Tm (cause problems for this person's swallowing. We saw this person in their\ wheelchair, )Tj 1 0 0 1 34.32001 219.23 Tm (leaning over to one side after lunch. This person is meant to sit up for\ 30 mins after )Tj 1 0 0 1 34.32001 201.73 Tm (eating. We saw that a member of staff put this person to bed soon after \ lunch, lying )Tj 1 0 0 1 34.32001 184.23 Tm (down. We asked staff about how this person is supported to eat and not c\ hoke. They )Tj 1 0 0 1 34.32001 166.73999 Tm (told us what they knew, but did not know that this person should be sat \ up for 30mins )Tj 1 0 0 1 34.32001 149.23999 Tm (after they had eaten. Staff told us this person has a pureed diet which \ complies with )Tj 1 0 0 1 34.32001 131.75 Tm (the SALT instructions. They also told us that they give this person cake\ and biscuits, )Tj 1 0 0 1 34.32001 114.25 Tm (which puts this person at risk of choking. The care plan does not contai\ n instructions )Tj 1 0 0 1 34.32001 96.75 Tm (for staff about what to do if this person chokes. One carer told us they\ would use their )Tj ET endstream endobj 543 0 obj 5253 endobj 544 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (common sense and try a grab and thrust movement. A nurse told us she hop\ ed that )Tj 1 0 0 1 34.32001 761.60004 Tm (staff would know to call a nurse or 999. This lack of instruction means \ that there may )Tj 1 0 0 1 34.32001 744.10999 Tm (be a delay in this person getting appropriate help.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We asked the manager how staff have been given information about this pe\ rson's )Tj 1 0 0 1 34.32001 691.62 Tm (needs and risk of choking since the most recent visit by the SALT. We we\ re told that )Tj 1 0 0 1 34.32001 674.12 Tm (the nurses had been told about the special requirements for this person,\ and the )Tj 1 0 0 1 34.32001 656.63 Tm (nurses were named, and that they give this information to the carers. We\ saw from )Tj 1 0 0 1 34.32001 639.13 Tm (the duty rota that one of these nurses had been on sick leave over this \ period. The )Tj 1 0 0 1 34.32001 621.63 Tm (manager confirmed this adding that the nurses already knew about the adv\ ice. We )Tj 1 0 0 1 34.32001 604.14001 Tm (reminded her that the SALT referral was made again because staff were no\ t following )Tj 1 0 0 1 34.32001 586.64001 Tm (the advice given, and this was putting this person at risk of choking.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We saw in the improvement plan provided by the owners that staff have ha\ d training )Tj 1 0 0 1 34.32001 534.14996 Tm (from the SALT in supporting people who have difficulties swallowing. Thi\ s document )Tj 1 0 0 1 34.32001 516.65997 Tm (also tells us that further updates will be given by the catering manager\ . This person is )Tj 1 0 0 1 34.32001 499.16 Tm (not qualified to do this and this is not good practice. We have checked \ with the SALT )Tj 1 0 0 1 34.32001 481.66998 Tm (and they have told us that they are happy to provide further training if\ needed.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We saw that many people living here have mobility problems. We checked c\ are plans )Tj 1 0 0 1 34.32001 429.17999 Tm (to see if people had had their moving and handling needs assessed. We fo\ und that )Tj 1 0 0 1 34.32001 411.67999 Tm (some people had not had these needs assessed. We found another that was \ dated )Tj 1 0 0 1 34.32001 394.19 Tm (April 2007 which had not been reviewed or updated since that time. Care \ plans give )Tj 1 0 0 1 34.32001 376.69 Tm (very general instructions for care staff such as 'needs hoist'. They did\ not specify the )Tj 1 0 0 1 34.32001 359.19 Tm (type of hoist to be used or the size of sling. We spoke to a nurse about\ how staff know )Tj 1 0 0 1 34.32001 341.70001 Tm (which hoist and sling to use. The nurse told us that if a person is on t\ he ground floor )Tj 1 0 0 1 34.32001 324.20001 Tm (they use the hoist that is on that floor and that carers make a judgment\ about what )Tj 1 0 0 1 34.32001 306.70999 Tm (size sling to use. This means that carers are not being supported to ens\ ure that they )Tj 1 0 0 1 34.32001 289.20999 Tm (use the appropriate equipment for each person.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (We also noted that the hoist is often used to help people who have been \ incontinent of )Tj 1 0 0 1 34.32001 236.72 Tm (urine. We saw that people share slings which does not help to prevent th\ e spread of )Tj 1 0 0 1 34.32001 219.23 Tm (infection and indicates that care is de-personalised.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Care plans in this home are in two parts. There is a larger comprehensiv\ e part which )Tj 1 0 0 1 34.32001 166.73999 Tm (contains details relating to the person and the plan of care. There is a\ lso a day to day )Tj 1 0 0 1 34.32001 149.23999 Tm (record which the manager told us is what carers use. Instructions in the\ se smaller )Tj 1 0 0 1 34.32001 131.75 Tm (records contain task orientated information such as needs feeding, hoist\ , weekly )Tj 1 0 0 1 34.32001 114.25 Tm (weight and on fluid chart. These are not person centred and do not give \ care staff the )Tj 1 0 0 1 34.32001 96.75 Tm (information they need to provide individualised care based on each perso\ n's individual )Tj ET endstream endobj 545 0 obj 4999 endobj 546 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs and preferences.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (Carers told us they do not tend to read care plans, although they do wri\ te in them. For )Tj 1 0 0 1 34.32001 726.60999 Tm (example they record fluid and food intake if people need to have this re\ corded. We )Tj 1 0 0 1 34.32001 709.10999 Tm (found that entries made by staff include impersonal comments such as pad\ changed, )Tj 1 0 0 1 34.32001 691.62 Tm (repositioned, soaking wet bed, usual day and nothing new. This type of l\ anguage is an )Tj 1 0 0 1 34.32001 674.12 Tm (indicator that the provision of care is task orientated and de personali\ sed.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (We asked how staff get the information they need about people and their \ needs if they )Tj 1 0 0 1 34.32001 621.63 Tm (do not read care plans. They told us they know people, or get to know th\ em. They say )Tj 1 0 0 1 34.32001 604.14001 Tm (they do not get a handover of information when they come on duty, that o\ nly the )Tj 1 0 0 1 34.32001 586.64001 Tm (nurse gets this. They say they start work straight away. They know who n\ eeds getting )Tj 1 0 0 1 34.32001 569.14996 Tm (up and who needs breakfast. We asked the temporary manager how it is ens\ ure that )Tj 1 0 0 1 34.32001 551.64996 Tm (carers have the information they need to care for people and were told t\ hat she would )Tj 1 0 0 1 34.32001 534.14996 Tm (hope nurses give this. This means there is not a robust system in place \ to ensure that )Tj 1 0 0 1 34.32001 516.65997 Tm (care staff have the information and guidance they need to ensure that pe\ ople's needs )Tj 1 0 0 1 34.32001 499.16 Tm (are met.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We saw that care plans are reviewed by nurses. However, we noted that de\ spite )Tj 1 0 0 1 34.32001 446.66998 Tm (changes in people's conditions that there were no changes to the plans o\ f care. We )Tj 1 0 0 1 34.32001 429.17999 Tm (also noted that reviews of care plans do not record what information has\ been used to )Tj 1 0 0 1 34.32001 411.67999 Tm (make the nursing decisions.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (The pharmacist inspector inspected the way that medicines are managed in\ this home. )Tj 1 0 0 1 34.32001 359.19 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 341.70001 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 324.20001 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 306.70999 Tm (were told that sometimes people can look after and take their own medici\ nes. There )Tj 1 0 0 1 34.32001 289.20999 Tm (are not any people living in the home at the moment who do this, and peo\ ple are )Tj 1 0 0 1 34.32001 271.70999 Tm (given their medicines by nursing staff.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (Medicines are stored safely for the protection of people in the home. Th\ ere are )Tj 1 0 0 1 34.32001 219.23 Tm (suitable arrangements for controlled drugs and any medicines requiring c\ old-storage.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Records are kept of medicines received into the home, and of any unwante\ d medicines )Tj 1 0 0 1 34.32001 166.73999 Tm (that are sent for destruction. Records are kept of medicines that are gi\ ven to people, )Tj 1 0 0 1 34.32001 149.23999 Tm (which helps to show that people receive their medicines as prescribed by\ the doctor. If )Tj 1 0 0 1 34.32001 131.75 Tm (a regularly prescribed dose is omitted, then a reason for this is record\ ed, as is good )Tj 1 0 0 1 34.32001 114.25 Tm (practice. Usually if a variable dose is prescribed there are clear recor\ ds to show how )Tj 1 0 0 1 34.32001 96.75 Tm (much is given, and this too is good practice.)Tj ET endstream endobj 547 0 obj 4862 endobj 548 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 686.21997 w 34.60001 468.30002 m 562.53998 468.30002 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 664.84998 w 33.47 456.47998 m 563.65997 456.47998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 121.86 l S 564.78998 791.10999 m 564.78998 121.86 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 122.93001 m 565.87 122.93001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We looked at some people's care plans to see what information is recorde\ d about their )Tj 1 0 0 1 34.32001 744.10999 Tm (medicines. We found written permission from the doctor to crush someone'\ s tablets )Tj 1 0 0 1 34.32001 726.60999 Tm (before giving. Staff had not asked if other forms of the same medicines \ are available, )Tj 1 0 0 1 34.32001 709.10999 Tm (such as soluble tablets or liquids, to make it easier for people to take\ . We found clear )Tj 1 0 0 1 34.32001 691.62 Tm (guidance for staff on when to administer medication that was prescribed \ to be given )Tj 1 0 0 1 34.32001 674.12 Tm ('when required'. This helps to show that people receive their medicines \ in the way )Tj 1 0 0 1 34.32001 656.63 Tm (their doctor intended for them.)Tj 1 0 0 1 34.32001 639.13 Tm (\240)Tj 1 0 0 1 34.32001 621.63 Tm (We looked at how people's privacy and dignity is maintained. We heard pe\ ople being )Tj 1 0 0 1 34.32001 604.14001 Tm (called by their preferred names and some people were able to tell us the\ y wear their )Tj 1 0 0 1 34.32001 586.64001 Tm (own clothes. We saw staff discreetly helping some people go to the toile\ t. However, )Tj 1 0 0 1 34.32001 569.14996 Tm (we also saw one person trying to attract the attention of staff who walk\ ed past or said )Tj 1 0 0 1 34.32001 551.64996 Tm ('hang on' as they walked past and did not come back. We heard one person\ saying no )Tj 1 0 0 1 34.32001 534.14996 Tm (repeatedly and we heard a carer saying 'yes, yes, yes' in a mocking fash\ ion.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We saw in the care plans of two people that they like to be or are washe\ d, shaved, )Tj 1 0 0 1 34.32001 481.66998 Tm (have their hair brushed and dressed whilst sitting on the commode. This \ is not a )Tj 1 0 0 1 34.32001 464.16998 Tm (dignified way to provide care. In addition a record of names of people w\ ho had taken )Tj 1 0 0 1 34.32001 446.66998 Tm (a bath is kept in the communal bathroom. This indicates an institutional\ approach to )Tj 1 0 0 1 34.32001 429.17999 Tm (people's personal care needs and to their confidentiality.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (We saw one person being hoisted to be taken to the toilet. When raised o\ ut of their )Tj 1 0 0 1 34.32001 376.69 Tm (seat there was a strong smell of urine. After they left the lounge, the \ smell persisted. )Tj 1 0 0 1 34.32001 359.19 Tm (We smelt the chair and found that the smell was coming from the fabric o\ f the chair, )Tj 1 0 0 1 34.32001 341.70001 Tm (and from the pressure relieving cushion on the chair. When staff returne\ d they put )Tj 1 0 0 1 34.32001 324.20001 Tm (this person back onto the chair. Each time this person shifted their wei\ ght in their )Tj 1 0 0 1 34.32001 306.70999 Tm (chair, there was an unpleasant odour of stale urine released.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj 1 0 0 1 34.32001 271.70999 Tm (We saw that two people share a bedroom. There are no records to show tha\ t each )Tj 1 0 0 1 34.32001 254.22 Tm (person has been consulted or made an informed choice about this, as shou\ ld happen. )Tj 1 0 0 1 34.32001 236.72 Tm (We saw that the room can be divided by a curtain. When we asked one pers\ on if this )Tj 1 0 0 1 34.32001 219.23 Tm (was used, they told us that it isn't always. Although this person says t\ hey don't mind, )Tj 1 0 0 1 34.32001 201.73 Tm (it is unclear what the other person sharing this room thinks or feels ab\ out this as they )Tj 1 0 0 1 34.32001 184.23 Tm (have communication difficulties.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (One health care professional commented that sometimes shared rooms creat\ e )Tj 1 0 0 1 34.32001 131.75 Tm (problems around privacy and dignity. )Tj ET endstream endobj 549 0 obj 5858 endobj 550 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 437.25 m 562.53998 437.25 l S 1 1 1 RG 22.5 w 32.35001 499.16998 m 564.78998 499.16998 l S 119.35001 w 33.47 426 m 563.65997 426 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87997 m 32.35001 364.12 l S 564.78998 487.87997 m 564.78998 364.12 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 365.20001 m 565.87 365.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Some people's quality of life is enhanced by continued links with their \ families and )Tj 1 0 0 1 36.62 409.25 Tm (friends and by the activities they take part in. However, not everyone i\ s having their )Tj 1 0 0 1 36.62 391.75998 Tm (individual social needs and rights to make choices met.)Tj 1 0 0 1 36.62 374.25998 Tm (People enjoy an appetising, balanced diet that meets their nutritional n\ eeds.)Tj 1 0 0 1 28.35001 349.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 257.30002 w 34.60001 210.67999 m 562.53998 210.67999 l S 1 1 1 RG 22.5 w 32.35001 330.32999 m 564.78998 330.32999 l S 235.92999 w 33.47 198.87 m 563.65997 198.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 317.95999 m 565.87 317.95999 l S 32.35001 319.03998 m 32.35001 78.70001 l S 564.78998 319.03998 m 564.78998 78.70001 l S 32.35001 317.95999 m 564.78998 317.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 327.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 302.26999 Tm (Since the last inspection the home has employed an activities co-ordinat\ or for 20 )Tj 1 0 0 1 36.57001 284.78 Tm (hours each week. This person is responsible for meeting the social needs\ of all the )Tj 1 0 0 1 36.57001 267.28 Tm (people living here and provides support with helping people to eat and w\ ith personal )Tj 1 0 0 1 36.57001 249.78999 Tm (care such as cutting people's nails.)Tj 1 0 0 1 36.57001 232.28999 Tm (\240)Tj 1 0 0 1 36.57001 214.78999 Tm (In surveys people told us there are usually activities they can take par\ t in if they want )Tj 1 0 0 1 36.57001 197.3 Tm (to. We saw that about 4 people who spend their time in the lounge are we\ ll attended )Tj 1 0 0 1 36.57001 179.8 Tm (to. We saw people took part in a picture quiz, in card games and in phys\ ical activity. )Tj 1 0 0 1 36.57001 162.31 Tm (These people were having fun, were being included, were relaxed and were\ treated )Tj 1 0 0 1 36.57001 144.81 Tm (with respect and with warmth. We saw that one person in particular is re\ ally )Tj 1 0 0 1 36.57001 127.31 Tm (benefiting from having this social interaction.)Tj 1 0 0 1 36.57001 109.82001 Tm (\240)Tj 1 0 0 1 36.57001 92.32001 Tm (We also saw the the lounge is laid out in such a way that separate areas\ have been )Tj ET endstream endobj 551 0 obj 4934 endobj 552 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (created. This means that people can take part in different activities or\ have )Tj 1 0 0 1 34.32001 761.60004 Tm (conversations without disturbing anyone else, and away from the televisi\ on. The )Tj 1 0 0 1 34.32001 744.10999 Tm (television was on throughout the day during this inspection. It was set \ to a very high )Tj 1 0 0 1 34.32001 726.60999 Tm (volume and no one was watching it. One person did take an interest when \ the )Tj 1 0 0 1 34.32001 709.10999 Tm (lunchtime news came on. They told us they like to hear the news, but tha\ t they're not )Tj 1 0 0 1 34.32001 691.62 Tm (bothered otherwise.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We saw one person enjoying knitting who also benefited from the activiti\ es organised. )Tj 1 0 0 1 34.32001 639.13 Tm (Other people were invited to join in and declined or were unable to do s\ o due to their )Tj 1 0 0 1 34.32001 621.63 Tm (disabilities.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (Other people living in this home spend time in their rooms. We spoke wit\ h staff about )Tj 1 0 0 1 34.32001 569.14996 Tm (how these people are supported to have their social needs met. We were t\ old the )Tj 1 0 0 1 34.32001 551.64996 Tm (activities co-ordinator spends time with these people in their rooms. We\ found that, )Tj 1 0 0 1 34.32001 534.14996 Tm (whilst well intentioned and very skillful, this person cannot meet the s\ ocial needs of all )Tj 1 0 0 1 34.32001 516.65997 Tm (the people living here. People who are physically or mentally disabled s\ pend long )Tj 1 0 0 1 34.32001 499.16 Tm (periods alone.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (One person told us they get bored lying in bed all day. Their relative s\ aid that staff )Tj 1 0 0 1 34.32001 446.66998 Tm (come into the room, but that this is to carry out care tasks such as tur\ ning. The care )Tj 1 0 0 1 34.32001 429.17999 Tm (plan for this person does not contain any information about their intere\ sts or religious )Tj 1 0 0 1 34.32001 411.67999 Tm (or spiritual needs.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Other care plans contain some information about people's interests. Howe\ ver, )Tj 1 0 0 1 34.32001 359.19 Tm (knowledge about these interests is not being used to meet each person's \ need to be )Tj 1 0 0 1 34.32001 341.70001 Tm (engaged and be social in an individualised way.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (For example each care plan has sections about people's spiritual needs. \ The care plan )Tj 1 0 0 1 34.32001 289.20999 Tm (of one person who has dementia states they are very religious and identi\ fies their )Tj 1 0 0 1 34.32001 271.70999 Tm (religion. The care plan section relating to social needs records that th\ is person loves to )Tj 1 0 0 1 34.32001 254.22 Tm (go out. The care plan does not identify how this person will be supporte\ d to attend a )Tj 1 0 0 1 34.32001 236.72 Tm (religious service or how they will be helped to go out. Staff tell us th\ is person does not )Tj 1 0 0 1 34.32001 219.23 Tm (go to church and does not go out. In addition, the part of the care plan\ relating to )Tj 1 0 0 1 34.32001 201.73 Tm (people's death and dying needs states that this person should be encoura\ ged to )Tj 1 0 0 1 34.32001 184.23 Tm (express their wishes regarding death as it approaches. This statement is\ used in all )Tj 1 0 0 1 34.32001 166.73999 Tm (the care plans we looked at where the section on death and dying had bee\ n )Tj 1 0 0 1 34.32001 149.23999 Tm (completed. This person's plan makes no mention of the arrangements this \ person )Tj 1 0 0 1 34.32001 131.75 Tm (might like in relation to their religion.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (Another person's care plan does not identify their social interests and \ we saw that this )Tj ET endstream endobj 553 0 obj 5000 endobj 554 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (person spent the day at the home in the lounge without being engaged in \ any activity.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We asked staff how decisions are made about who gets up early or late. S\ taff told us )Tj 1 0 0 1 34.32001 726.60999 Tm ('the diabetics are always got up first and that after that it depends on\ where the )Tj 1 0 0 1 34.32001 709.10999 Tm (member of staff decides to start work'. This indicates that people are n\ ot offered )Tj 1 0 0 1 34.32001 691.62 Tm (choice.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We found that the care plan for one person contains a recently written s\ tatement that )Tj 1 0 0 1 34.32001 639.13 Tm (they like to get up at 6am. It also states that the nurse writing this h\ as discussed this )Tj 1 0 0 1 34.32001 621.63 Tm (with the person and that they agree with this. This person is described \ in the care plan )Tj 1 0 0 1 34.32001 604.14001 Tm (as having dementia and being confused. We found this statement in the ca\ re plan of )Tj 1 0 0 1 34.32001 586.64001 Tm (another person who is also described as having dementia. This means that\ people who )Tj 1 0 0 1 34.32001 569.14996 Tm (cannot speak up for themselves do not make decisions and do not have con\ trol over )Tj 1 0 0 1 34.32001 551.64996 Tm (their individual daily lives.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj 1 0 0 1 34.32001 516.65997 Tm (Visitors told us they can visit when they like. And we saw visitors in t\ he home at )Tj 1 0 0 1 34.32001 499.16 Tm (different times of the day and evening. Some people say that staff keep \ them up to )Tj 1 0 0 1 34.32001 481.66998 Tm (date with changes and developments and others say that staff don't do th\ is.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (In surveys people told us they always like the food served in the home. \ People we )Tj 1 0 0 1 34.32001 429.17999 Tm (spoke with say they like the variety and the quality of food served. We \ heard staff )Tj 1 0 0 1 34.32001 411.67999 Tm (asking people what they would like for lunch, close to the time this was\ being served. )Tj 1 0 0 1 34.32001 394.19 Tm (This means that people are helped to make a choice about what to eat at \ a time when )Tj 1 0 0 1 34.32001 376.69 Tm (they are ready to make this decision and when it means something to them\ . We were )Tj 1 0 0 1 34.32001 359.19 Tm (unsure how staff helped people who cannot speak for themselves to make d\ ecisions )Tj 1 0 0 1 34.32001 341.70001 Tm (about what to eat. We asked a member of care staff who told us that they\ get to know )Tj 1 0 0 1 34.32001 324.20001 Tm (what people like. We saw in care plans that there are records about some\ people's )Tj 1 0 0 1 34.32001 306.70999 Tm (likes and dislikes, but not for all people. We saw records relating to w\ hat one person )Tj 1 0 0 1 34.32001 289.20999 Tm (eats. We saw that they have porridge for breakfast every day as far back\ as we saw )Tj 1 0 0 1 34.32001 271.70999 Tm (records for \(approximately 11 weeks\). They had also had scrambled egg \ for supper for )Tj 1 0 0 1 34.32001 254.22 Tm (the majority of those 11 weeks. Staff told us that this person sometimes\ does not eat )Tj 1 0 0 1 34.32001 236.72 Tm (much at supper and on the day of this inspection staff told us this pers\ on only ate 2 )Tj 1 0 0 1 34.32001 219.23 Tm (small spoonfuls of supper. The records and conversations with staff do n\ ot indicate )Tj 1 0 0 1 34.32001 201.73 Tm (that staff had explored the possibility that this person might be bored \ with their )Tj 1 0 0 1 34.32001 184.23 Tm (supper diet.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We heard that one person who spends all their time in their bedroom had \ not had )Tj 1 0 0 1 34.32001 131.75 Tm (breakfast on two occasions and that their morning tea had been missed a \ couple of )Tj 1 0 0 1 34.32001 114.25 Tm (times.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 555 0 obj 1224 endobj 556 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We also saw two people being supported to eat by staff whilst in their b\ edrooms. The )Tj 1 0 0 1 34.32001 761.60004 Tm (support given was unhurried, relaxed and sensitive. )Tj ET endstream endobj 557 0 obj 5679 endobj 558 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 505.73999 m 562.53998 505.73999 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 84.36 w 33.47 494.5 m 563.65997 494.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 450.12 l S 564.78998 538.88 m 564.78998 450.12 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 451.19 m 565.87 451.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People concerns are not always acted upon and people are not fully safeg\ uarded from )Tj 1 0 0 1 36.62 460.25 Tm (harm. )Tj 1 0 0 1 28.35001 435.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 343.30002 w 34.60001 253.67 m 562.53998 253.67 l S 1 1 1 RG 22.5 w 32.35001 416.31998 m 564.78998 416.31998 l S 321.92999 w 33.47 241.86 m 563.65997 241.86 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 403.94998 m 565.87 403.94998 l S 32.35001 405.03 m 32.35001 78.70001 l S 564.78998 405.03 m 564.78998 78.70001 l S 32.35001 403.94998 m 564.78998 403.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 413.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 388.26999 Tm (In surveys all 3 people told us that they know how to make a formal comp\ laint and 2 )Tj 1 0 0 1 36.57001 370.76999 Tm (told us there is someone they can speak with informally if they are not \ happy. One )Tj 1 0 0 1 36.57001 353.26999 Tm (person said they can only do this with their visitors.)Tj 1 0 0 1 36.57001 335.78 Tm (\240)Tj 1 0 0 1 36.57001 318.28 Tm (The information given to us in the AQAA tells us that this home has rece\ ived one )Tj 1 0 0 1 36.57001 300.78998 Tm (complaint since the last inspection a year ago. This was dealt with by t\ he home within )Tj 1 0 0 1 36.57001 283.29001 Tm (28 days, which is the timescale set, and it was upheld. It also tells us\ that one )Tj 1 0 0 1 36.57001 265.79001 Tm (safeguarding alert was made alleging that someone living at the home was\ not )Tj 1 0 0 1 36.57001 248.3 Tm (receiving care that was safe. This was investigated by the safeguarding \ team in May )Tj 1 0 0 1 36.57001 230.8 Tm (2009. The outcome of this was that the care provided was not neglectful \ or abusive, )Tj 1 0 0 1 36.57001 213.31 Tm (but was poor practice.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Since then the commission has received two complaints about the quality \ of care, )Tj 1 0 0 1 36.57001 160.81999 Tm (about staff not being available when needed, about the management of med\ icines and )Tj 1 0 0 1 36.57001 143.31999 Tm (about the general management of the home. One person said they had bough\ t their )Tj 1 0 0 1 36.57001 125.83 Tm (concerns to the attention of staff but did not get a satisfactory respon\ se. Another )Tj 1 0 0 1 36.57001 108.33 Tm (person said they thought that staff were not taking their concerns serio\ usly enough.)Tj 1 0 0 1 36.57001 90.83 Tm (\240)Tj ET endstream endobj 559 0 obj 5335 endobj 560 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We have looked at some of these issues during this inspection and are wo\ rking with )Tj 1 0 0 1 34.32001 761.60004 Tm (the safeguarding team who are undertaking an investigation relating to t\ hese )Tj 1 0 0 1 34.32001 744.10999 Tm (allegations. In addition Devon County Council are reviewing the care of \ the people )Tj 1 0 0 1 34.32001 726.60999 Tm (living here.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (The AQAA tells us that no one living here is subject to any form of rest\ raint. However, )Tj 1 0 0 1 34.32001 674.12 Tm (a referral was made under the Deprivation of Liberty and Mental Capacity\ Act because )Tj 1 0 0 1 34.32001 656.63 Tm (one person is being restrained in their wheelchair. This is not a depriv\ ation of liberty )Tj 1 0 0 1 34.32001 639.13 Tm (but is a form of restraint. We saw that this continues. We also saw in a\ care plan that )Tj 1 0 0 1 34.32001 621.63 Tm (another person is restrained in their chair by using a lap belt when the\ y try to stand )Tj 1 0 0 1 34.32001 604.14001 Tm (up. We saw that people have bed rails whilst in their beds, which is ano\ ther form of )Tj 1 0 0 1 34.32001 586.64001 Tm (restraint. There is some indication that the restraint used for people w\ hilst sitting in )Tj 1 0 0 1 34.32001 569.14996 Tm (their chairs might not always be appropriate. This is because records st\ ate that it is )Tj 1 0 0 1 34.32001 551.64996 Tm (used when people try to stand up or get agitated. The use of restraint i\ s sometimes )Tj 1 0 0 1 34.32001 534.14996 Tm (the only action that can be taken to keep someone safe. However, records\ should )Tj 1 0 0 1 34.32001 516.65997 Tm (show that all other actions to reduce risk have been tried before this a\ ction is taken. )Tj 1 0 0 1 34.32001 499.16 Tm (In addition, care plans do not give clear and specific instructions as t\ o when restraint )Tj 1 0 0 1 34.32001 481.66998 Tm (should be used and for how long. We asked staff about the use of restrai\ nt in the form )Tj 1 0 0 1 34.32001 464.16998 Tm (of a lap belt for one person. They told us that they use it only when ne\ eded, when )Tj 1 0 0 1 34.32001 446.66998 Tm (staff are not around, and for a few hours. This means that restraint is \ being used for )Tj 1 0 0 1 34.32001 429.17999 Tm (long periods when staff are not around to supervise vulnerable and agita\ ted people.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (People who live here are having decisions about forms of restraint made \ by staff or )Tj 1 0 0 1 34.32001 376.69 Tm (relatives. Sometimes this has to happen if the person involved is not ab\ le to make )Tj 1 0 0 1 34.32001 359.19 Tm (these decisions for themselves. The circumstances of these decisions sho\ uld be )Tj 1 0 0 1 34.32001 341.70001 Tm (recorded so that it is clear that these decisions are being made in the \ best interests of )Tj 1 0 0 1 34.32001 324.20001 Tm (that person. Such records are not being kept for people living in this h\ ome.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We saw three people who have bruises or broken skin. We asked staff abou\ t these. )Tj 1 0 0 1 34.32001 271.70999 Tm (They gave us explanations for two but staff did not know what had caused\ the third )Tj 1 0 0 1 34.32001 254.22 Tm (injury. We saw in care records that one person's injury had been caused \ when they )Tj 1 0 0 1 34.32001 236.72 Tm (had resisted care. The circumstances of this have not been investigated \ and actions )Tj 1 0 0 1 34.32001 219.23 Tm (have not been taken to prevent this happening again. Another person inju\ red them )Tj 1 0 0 1 34.32001 201.73 Tm (self on a bed rail and there are no records to show that actions have be\ en taken to )Tj 1 0 0 1 34.32001 184.23 Tm (prevent this happening again.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We spoke with staff about what they would do if they saw or suspected ab\ use. They )Tj 1 0 0 1 34.32001 131.75 Tm (told us they would tell the nurse in charge, as is good practice. We ask\ ed the nurse in )Tj 1 0 0 1 34.32001 114.25 Tm (charge what they would do, and the actions they describe are contrary to\ the guidance )Tj 1 0 0 1 34.32001 96.75 Tm (given in the multi-agency guidance. This person told us that they had re\ ceived )Tj ET endstream endobj 561 0 obj 1252 endobj 562 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (training and had a copy of the guidance in the home. However, the guidan\ ce they )Tj 1 0 0 1 34.32001 761.60004 Tm (showed us would not guide them to take appropriate action if abuse were \ suspected. )Tj ET endstream endobj 563 0 obj 5720 endobj 564 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 488.73999 m 562.53998 488.73999 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 84.36 w 33.47 477.5 m 563.65997 477.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 433.12 l S 564.78998 521.88 m 564.78998 433.12 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 434.19 m 565.87 434.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (People living here enjoy a homely environment. However, improvements are\ needed )Tj 1 0 0 1 36.62 443.25 Tm (to ensure that people are fully protected from infection. )Tj 1 0 0 1 28.35001 418.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 326.30002 w 34.60001 245.17 m 562.53998 245.17 l S 1 1 1 RG 22.5 w 32.35001 399.31998 m 564.78998 399.31998 l S 304.92999 w 33.47 233.36 m 563.65997 233.36 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 386.94998 m 565.87 386.94998 l S 32.35001 388.03 m 32.35001 78.70001 l S 564.78998 388.03 m 564.78998 78.70001 l S 32.35001 386.94998 m 564.78998 386.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 396.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 371.26999 Tm (In surveys people told us that the home is usually clean and fresh. On t\ he day we )Tj 1 0 0 1 36.57001 353.76999 Tm (visited we found it to be clean and odour free.)Tj 1 0 0 1 36.57001 336.26999 Tm (\240)Tj 1 0 0 1 36.57001 318.78 Tm (The home is warm, and is furnished and decorated in a domestic and homel\ y style. )Tj 1 0 0 1 36.57001 301.28 Tm (There is a reception area in the large hall, where there is usually a me\ mber of staff )Tj 1 0 0 1 36.57001 283.79001 Tm (during the day so that people visiting the home can speak with them. The\ re is also a )Tj 1 0 0 1 36.57001 266.29001 Tm (large board in the hall displaying the photographs and names of the staf\ f working at )Tj 1 0 0 1 36.57001 248.78999 Tm (the home. This is helpful so that people can identify and become familia\ r with staff.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The home has one large lounge and a dining room. Both are decorated and \ furnished )Tj 1 0 0 1 36.57001 196.31 Tm (in a homely style. The tables in the dining room are smaller and this he\ lps people to )Tj 1 0 0 1 36.57001 178.81 Tm (sit in smaller groups and to experience meals as a social occasion. The \ lounge is )Tj 1 0 0 1 36.57001 161.31 Tm (divided into smaller seating areas so that people can carry out differen\ t activities )Tj 1 0 0 1 36.57001 143.81999 Tm (without disturbing others. This area is very bright as it has large wind\ ows to the side )Tj 1 0 0 1 36.57001 126.32001 Tm (and rear of the house.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (We saw staff washing their hands and wearing protective clothing as a wa\ y of helping )Tj ET endstream endobj 565 0 obj 2517 endobj 566 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (to prevent the spread of infection. Staff use alcohol gel as another way\ of preventing )Tj 1 0 0 1 34.32001 761.60004 Tm (the spread of infection, and this is also available for visitors to the \ home to use.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we saw that the sluice did not have liquid soap for staff to wa\ sh their hands, )Tj 1 0 0 1 34.32001 709.10999 Tm (and that some soap dispensers appear dirty and one was empty.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last inspection by the commission the home have also been visi\ ted by the )Tj 1 0 0 1 34.32001 656.63 Tm (fire authority. Some actions were required and these have been carried o\ ut. We saw )Tj 1 0 0 1 34.32001 639.13 Tm (that access from the home is controlled at the front door by a key pad s\ ystem and )Tj 1 0 0 1 34.32001 621.63 Tm (were told that this is linked to the fire alarm. This means that when th\ e fire alarm )Tj 1 0 0 1 34.32001 604.14001 Tm (sounds that the door lock will automatically be opened, and is good prac\ tice.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We were told that some areas of the home have been redecorated. We saw o\ ne )Tj 1 0 0 1 34.32001 551.64996 Tm (upstairs window being replaced. We saw that staff test and record the te\ mperature of )Tj 1 0 0 1 34.32001 534.14996 Tm (bathing water as is good practice to ensure that accidental scalding is \ prevented. )Tj ET endstream endobj 567 0 obj 5784 endobj 568 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 480 m 562.53998 480 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 101.85001 w 33.47 468.75 m 563.65997 468.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 415.62 l S 564.78998 521.88 m 564.78998 415.62 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 416.70001 m 565.87 416.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (There are not always enough staff on duty with the appropriate qualifica\ tions, training )Tj 1 0 0 1 36.62 443.25 Tm (and skills to care for people living here. Practices in relation to recr\ uitment are placing )Tj 1 0 0 1 36.62 425.75998 Tm (people at risk of harm. )Tj 1 0 0 1 28.35001 401.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 308.80002 w 34.60001 236.42999 m 562.53998 236.42999 l S 1 1 1 RG 22.5 w 32.35001 381.82999 m 564.78998 381.82999 l S 287.42999 w 33.47 224.62 m 563.65997 224.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 369.44998 m 565.87 369.44998 l S 32.35001 370.53 m 32.35001 78.70001 l S 564.78998 370.53 m 564.78998 78.70001 l S 32.35001 369.44998 m 564.78998 369.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 378.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 353.76999 Tm (This is a nursing home and should have a registered nurse on duty throug\ hout the day )Tj 1 0 0 1 36.57001 336.26999 Tm (and night. We were contacted by a person who was concerned this was not \ )Tj 1 0 0 1 36.57001 318.78 Tm (happening. We contacted the home and it was confirmed that on one night \ there was )Tj 1 0 0 1 36.57001 301.28 Tm (not a nurse on duty. We asked the owner why they had not used an agency \ nurse to )Tj 1 0 0 1 36.57001 283.79001 Tm (cover this shift. They told us that this home never uses agency staff. T\ hey told us that )Tj 1 0 0 1 36.57001 266.29001 Tm (due to staff sickness they had arranged for a nurse to sleep at the home\ on that night. )Tj 1 0 0 1 36.57001 248.78999 Tm (This practice puts people at risk.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The caller was also concerned that there are not enough staff on duty. W\ e spoke to )Tj 1 0 0 1 36.57001 196.31 Tm (the owner about this. She told us that staffing has been reduced but tha\ t there are )Tj 1 0 0 1 36.57001 178.81 Tm (enough staff on duty to meet people's current needs. We looked at the du\ ty rota and )Tj 1 0 0 1 36.57001 161.31 Tm (saw that there had previously been 3 or 4 carers on duty in the morning \ and this had )Tj 1 0 0 1 36.57001 143.81999 Tm (been reduced to 2 or 3 carers. In the afternoon we saw that there used t\ o be 2 or 3 )Tj 1 0 0 1 36.57001 126.32001 Tm (carers on duty in the afternoon, and now there are 2. On the day of this\ inspection )Tj 1 0 0 1 36.57001 108.83 Tm (there was a nurse on duty with 3 carers, an administrator, cook and the \ temporary )Tj 1 0 0 1 36.57001 91.33 Tm (manager.)Tj ET endstream endobj 569 0 obj 4923 endobj 570 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We saw in the information given to us by the home prior to the inspectio\ n that there )Tj 1 0 0 1 34.32001 744.10999 Tm (are 14 people living at the home who need help with undressing and dress\ ing, and )Tj 1 0 0 1 34.32001 726.60999 Tm (need help to go to the toilet. 11 people are incontinent of both faeces \ and urine and 8 )Tj 1 0 0 1 34.32001 709.10999 Tm (people have dementia. 11 people need two members of staff to help them w\ ith their )Tj 1 0 0 1 34.32001 691.62 Tm (care.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (In surveys one person told us that staff are usually available, one that\ staff are )Tj 1 0 0 1 34.32001 639.13 Tm (sometimes available and one that staff are never available when needed. \ Comments )Tj 1 0 0 1 34.32001 621.63 Tm (included staff are not always available, and the home is very short of s\ taff. The )Tj 1 0 0 1 34.32001 604.14001 Tm (surveys also asked what the home could do better. People said employ mor\ e staff who )Tj 1 0 0 1 34.32001 586.64001 Tm (can speak and understand English and train and employ more staff especia\ lly at night. )Tj 1 0 0 1 34.32001 569.14996 Tm (Staff were however described as nice and lovely.)Tj 1 0 0 1 34.32001 551.64996 Tm (\240)Tj 1 0 0 1 34.32001 534.14996 Tm (We looked at the records relating to falls and injuries. According to th\ ese records )Tj 1 0 0 1 34.32001 516.65997 Tm (people have been found to have fallen when there have been no staff pres\ ent on 14 )Tj 1 0 0 1 34.32001 499.16 Tm (separate occasions since the beginning of July this year. This means tha\ t people are )Tj 1 0 0 1 34.32001 481.66998 Tm (not being sufficiently supervised by staff to keep them safe.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We know that these accident records are incomplete. We are aware that on\ e person )Tj 1 0 0 1 34.32001 429.17999 Tm (has fallen whilst alone, and this is not recorded. We also saw that two \ people had )Tj 1 0 0 1 34.32001 411.67999 Tm (injuries which have not been recorded as accidents or incidents.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We looked at the duty rota and found that is is not always accurate. For\ example, on )Tj 1 0 0 1 34.32001 359.19 Tm (some weeks the manager, who has left the home, is recorded as on duty. I\ n addition, )Tj 1 0 0 1 34.32001 341.70001 Tm (the temporary manager has not been included on the duty rota until Septe\ mber )Tj 1 0 0 1 34.32001 324.20001 Tm (although they say they started work at the home in August.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We asked to see the records of staff training. We were told that these a\ re incomplete )Tj 1 0 0 1 34.32001 271.70999 Tm (because the records about training have gone missing since the manager l\ eft the )Tj 1 0 0 1 34.32001 254.22 Tm (home. We saw that some records had been made about training, but that th\ ere were )Tj 1 0 0 1 34.32001 236.72 Tm (large gaps. The management team tell us that this means they are not ful\ ly aware of )Tj 1 0 0 1 34.32001 219.23 Tm (what training staff have had, and what training might be needed. We did \ see a notice )Tj 1 0 0 1 34.32001 201.73 Tm (that said that training has been arranged for staff in relation preventi\ ng people from )Tj 1 0 0 1 34.32001 184.23 Tm (falling.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (Staff told us they had had some training. One told us they had had train\ ing in how to )Tj 1 0 0 1 34.32001 131.75 Tm (provide care to people, another that they thought they had had training \ in relation to )Tj 1 0 0 1 34.32001 114.25 Tm (supporting people who have problems with swallowing. However, they went \ on to )Tj 1 0 0 1 34.32001 96.75 Tm (describe training which relates to nutritional supplements. One person t\ hought they )Tj ET endstream endobj 571 0 obj 2380 endobj 572 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 266.32001 w 34.60001 678.25 m 562.53998 678.25 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 244.93999 w 33.47 666.44 m 563.65997 666.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 541.76001 l S 564.78998 791.10999 m 564.78998 541.76001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 542.83997 m 565.87 542.83997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (had had training about dementia, and gave a description of how to care f\ or someone )Tj 1 0 0 1 34.32001 761.60004 Tm (with dementia which was an example of good practice.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we also saw that staff record that people have drunk more than \ they have. )Tj 1 0 0 1 34.32001 709.10999 Tm (We heard staff trying to persuade a confused person that their understan\ ding of a )Tj 1 0 0 1 34.32001 691.62 Tm (situation was wrong, causing distress and confusion to this person. We a\ lso saw staff )Tj 1 0 0 1 34.32001 674.12 Tm (ignoring one person who was trying to attract their attention.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (The AQAA told us that 10 of the 12 carers working at this home have achi\ eved a )Tj 1 0 0 1 34.32001 621.63 Tm (National Vocational Qualification \(NVQ\) in care, to level 2 or above. \ We asked the )Tj 1 0 0 1 34.32001 604.14001 Tm (manager if there is a system in place to ensure that staff practice the \ skills they are )Tj 1 0 0 1 34.32001 586.64001 Tm (taught, and to ensure they do this to the level of quality that is expec\ ted. The )Tj 1 0 0 1 34.32001 569.14996 Tm (manager told us that this is the nurses responsibility and that there is\ no formal )Tj 1 0 0 1 34.32001 551.64996 Tm (system.)Tj ET endstream endobj 573 0 obj 5831 endobj 574 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 395 m 562.53998 395 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 101.85001 w 33.47 383.75 m 563.65997 383.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 330.62 l S 564.78998 436.88 m 564.78998 330.62 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 331.70001 m 565.87 331.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of leadership in this home means that systems are not in place to e\ nsure that )Tj 1 0 0 1 36.62 358.25 Tm (people receive the care they need to an acceptable standard in a way tha\ t promotes )Tj 1 0 0 1 36.62 340.75998 Tm (their safety. )Tj 1 0 0 1 28.35001 316.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.8 w 34.60001 193.92999 m 562.53998 193.92999 l S 1 1 1 RG 22.5 w 32.35001 296.82999 m 564.78998 296.82999 l S 202.42999 w 33.47 182.12 m 563.65997 182.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 284.44998 m 565.87 284.44998 l S 32.35001 285.53 m 32.35001 78.70001 l S 564.78998 285.53 m 564.78998 78.70001 l S 32.35001 284.44998 m 564.78998 284.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.76999 Tm (This home does not have a Registered Manager. The previous manager left \ in August )Tj 1 0 0 1 36.57001 251.26999 Tm (2009. Since that time the home has been managed on a temporary basis. Th\ e )Tj 1 0 0 1 36.57001 233.78 Tm (temporary manager is a Registered Nurse and is studying for a Leadership\ and )Tj 1 0 0 1 36.57001 216.28 Tm (Management qualification. She had been working as the \(unregistered\) m\ anager of )Tj 1 0 0 1 36.57001 198.78999 Tm (the owners' residential home, and works from 9am - 3pm four days weekly.\ She is )Tj 1 0 0 1 36.57001 181.28999 Tm (supernumerary to nursing hours and is supported by two of the four owner\ s of this )Tj 1 0 0 1 36.57001 163.78999 Tm (home, who are also nurses.)Tj 1 0 0 1 36.57001 146.3 Tm (\240)Tj 1 0 0 1 36.57001 128.8 Tm (In the last few months the commission has received comments from relativ\ es of )Tj 1 0 0 1 36.57001 111.31 Tm (people living here who say the overall management of the home has declin\ ed. One )Tj 1 0 0 1 36.57001 93.81 Tm (person described the management as chaotic, saying that this has resulte\ d in people )Tj ET endstream endobj 575 0 obj 5070 endobj 576 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (not getting the care they need.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked to see if there are systems in place to ensure the home runs e\ fficiently and )Tj 1 0 0 1 34.32001 726.60999 Tm (safely, and that people get the care they need. We found that systems ar\ e not robust )Tj 1 0 0 1 34.32001 709.10999 Tm (enough to achieve this.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (For example we looked at the system for communicating peoples' needs and\ changing )Tj 1 0 0 1 34.32001 656.63 Tm (needs, and for ensuring that peoples' needs are met. The owners and mana\ ger told us )Tj 1 0 0 1 34.32001 639.13 Tm (that this is achieved through the care planning system. However, we foun\ d that these )Tj 1 0 0 1 34.32001 621.63 Tm (documents are complex and contradictory in places. They do not always pr\ ovide the )Tj 1 0 0 1 34.32001 604.14001 Tm (level of detail needed by staff to ensure that they have the information\ they need, and )Tj 1 0 0 1 34.32001 586.64001 Tm (to ensure that people's needs are met in a way that is consistent and of\ a satisfactory )Tj 1 0 0 1 34.32001 569.14996 Tm (quality. We found that reviews of people's care do not include all the i\ nformation )Tj 1 0 0 1 34.32001 551.64996 Tm (available and do not always provide evidence for some of the care decisi\ ons made )Tj 1 0 0 1 34.32001 534.14996 Tm (\(see Health and Personal Care\). Care staff told us they do not read ca\ re plans. We )Tj 1 0 0 1 34.32001 516.65997 Tm (asked if they got a hand over of information at the beginning of each sh\ ift and they )Tj 1 0 0 1 34.32001 499.16 Tm (told us they do not. We asked the manager how information is relayed to \ staff. She )Tj 1 0 0 1 34.32001 481.66998 Tm (told us that she expects the nurses to do this. The evidence in the Heal\ th and Personal )Tj 1 0 0 1 34.32001 464.16998 Tm (Care section of this report, shows that this is not happening.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked closely at how some decisions about people's care are made. Fo\ r example, )Tj 1 0 0 1 34.32001 411.67999 Tm (one record states that one person cannot make a decision about having be\ d rails on )Tj 1 0 0 1 34.32001 394.19 Tm (their bed. However, records show that this person has made a decision ab\ out having )Tj 1 0 0 1 34.32001 376.69 Tm (repeated invasive procedures. Another person can make the decision to ge\ t up at 6am )Tj 1 0 0 1 34.32001 359.19 Tm (but cannot make a decision about what they eat.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at how risks in the home are managed. We found that people are\ identified )Tj 1 0 0 1 34.32001 306.70999 Tm (as being at risk of falling. Care records instruct staff to observe them\ . Records show )Tj 1 0 0 1 34.32001 289.20999 Tm (that a lot of falls have happened to people when staff are not present. \ Although there )Tj 1 0 0 1 34.32001 271.70999 Tm (is a system for recording this information, there is not a system for mo\ nitoring and )Tj 1 0 0 1 34.32001 254.22 Tm (analysing this information, and therefore actions have not been taken to\ help prevent )Tj 1 0 0 1 34.32001 236.72 Tm (and reduce the number of falls.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (We looked to see if there is a safe system in place for moving and handl\ ing people )Tj 1 0 0 1 34.32001 184.23 Tm (with mobility problems. We found that assessments have not been carried \ out or had )Tj 1 0 0 1 34.32001 166.73999 Tm (been carried out a long time ago and have not been reviewed. We found th\ at decisions )Tj 1 0 0 1 34.32001 149.23999 Tm (about the type of equipment to be used are based on the equipment that i\ s available )Tj 1 0 0 1 34.32001 131.75 Tm (and not on what would be the most suitable for each person. The manager \ reports )Tj 1 0 0 1 34.32001 114.25 Tm (that staff have not had training in how to carry out moving and handling\ assessments.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 577 0 obj 5058 endobj 578 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We looked at how other risks in the home have been managed. We found tha\ t the )Tj 1 0 0 1 34.32001 761.60004 Tm (temperature of hot water is restricted to help ensure that people are no\ t scalded. We )Tj 1 0 0 1 34.32001 744.10999 Tm (found that windows have restricted openings to prevent people falling. H\ owever, we )Tj 1 0 0 1 34.32001 726.60999 Tm (found one window, that had been replaced that day, did not have a restri\ cted opening. )Tj 1 0 0 1 34.32001 709.10999 Tm (We told one of the owners who told us they thought that it had been rest\ ricted since )Tj 1 0 0 1 34.32001 691.62 Tm (we last looked. When we looked again, it had not.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked in the kitchen and found it clean and tidy. The owners identif\ ied )Tj 1 0 0 1 34.32001 639.13 Tm (approximately 4 years ago that the kitchen is coming to the end of its u\ seful life, and )Tj 1 0 0 1 34.32001 621.63 Tm (the Environmental Health Officer also identified this. The cook reports \ that a )Tj 1 0 0 1 34.32001 604.14001 Tm (refurbishment date has not yet been set.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We looked at how equipment is maintained. We found that the weighing sca\ les had )Tj 1 0 0 1 34.32001 551.64996 Tm (been weighing inaccurately for some time meaning that people at risk of \ malnutrition )Tj 1 0 0 1 34.32001 534.14996 Tm (could not be weighed accurately. The lift broke down for at least 2 days\ in October.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We looked at how the home involve people in the running of the home and \ how the )Tj 1 0 0 1 34.32001 481.66998 Tm (management team get feedback from people and improve the quality of care\ given. )Tj 1 0 0 1 34.32001 464.16998 Tm (We were told by relatives that meetings are sometimes held to which they\ are invited. )Tj 1 0 0 1 34.32001 446.66998 Tm (One person told us at that at the last meeting they had been informed th\ ere were )Tj 1 0 0 1 34.32001 429.17999 Tm (going to be a lot of changes in the home. They asked for, and the manage\ ment team )Tj 1 0 0 1 34.32001 411.67999 Tm (agreed they could have, a list of these changes so that they could prepa\ re their parent )Tj 1 0 0 1 34.32001 394.19 Tm (for these changes. They have not received this.)Tj 1 0 0 1 34.32001 376.69 Tm (\240)Tj 1 0 0 1 34.32001 359.19 Tm (We looked at the results of the most recent quality assurance survey \(J\ une 2009\). )Tj 1 0 0 1 34.32001 341.70001 Tm (Some people had said they were not satisfied with the length of time it \ took to answer )Tj 1 0 0 1 34.32001 324.20001 Tm (call bells. One person said that new staff were not given enough trainin\ g meaning that )Tj 1 0 0 1 34.32001 306.70999 Tm (they had to take instruction from the person they were meant to be carin\ g for. Two )Tj 1 0 0 1 34.32001 289.20999 Tm (people thought that improvements should be made to laundry and one to ir\ oning. We )Tj 1 0 0 1 34.32001 271.70999 Tm (asked how these issues had been addressed and the owner did not know bec\ ause the )Tj 1 0 0 1 34.32001 254.22 Tm (survey was carried out when the previous manager was employed.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We checked to see if previous requirements set by the commission have be\ en met. )Tj 1 0 0 1 34.32001 201.73 Tm (We found that requirements relating to health and welfare, care planning\ , )Tj 1 0 0 1 34.32001 184.23 Tm (safeguarding people, meeting people's social needs, staff skills and imp\ roving the )Tj 1 0 0 1 34.32001 166.73999 Tm (overall management have not been met.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We did not check any personal allowance accounts of the people living he\ re as the )Tj 1 0 0 1 34.32001 114.25 Tm (home does not hold any money on behalf of people. Instead they run a deb\ it account, )Tj 1 0 0 1 34.32001 96.75 Tm (recording all monies spent on people's behalf. Records and receipts are \ given to )Tj ET endstream endobj 579 0 obj 1648 endobj 580 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (35)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 126.35001 w 34.60001 748.22998 m 562.53998 748.22998 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 104.98 w 33.47 736.41998 m 563.65997 736.41998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 681.72998 l S 564.78998 791.10999 m 564.78998 681.72998 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 682.81 m 565.87 682.81 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (relatives and supporters for them to check and to pay for retrospectivel\ y.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (During our inspection it came to light that the commission are not being\ notified of all )Tj 1 0 0 1 34.32001 726.60999 Tm (incidents that affect the welfare of people living here as they should b\ e. 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They )Tj 1 0 0 1 294.54999 448.95999 Tm (must record their findings )Tj 1 0 0 1 294.54999 434.38 Tm (and send these to the )Tj 1 0 0 1 294.54999 419.80002 Tm (commission after each visit.)Tj 1 0 0 1 294.54999 405.22 Tm (\240)Tj 1 0 0 1 294.54999 390.63998 Tm (Previous timescale of )Tj 1 0 0 1 294.54999 376.06 Tm (13/04/07 not met.)Tj 1 0 0 1 294.54999 361.47998 Tm (\240)Tj 1 0 0 1 294.54999 346.89999 Tm (Not inspected on this )Tj 1 0 0 1 294.54999 332.32001 Tm (occasion. 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This )Tj 1 0 0 1 298.04999 446.73999 Tm (assessment must include )Tj 1 0 0 1 298.04999 429.73999 Tm (health and social care )Tj 1 0 0 1 298.04999 412.73999 Tm (assessments if the )Tj 1 0 0 1 298.04999 395.73999 Tm (placement takes place )Tj 1 0 0 1 298.04999 378.73999 Tm (through health or social care )Tj 1 0 0 1 298.04999 361.73999 Tm (services. )Tj 1 0 0 1 298.04999 344.73999 Tm (\240)Tj 1 0 0 1 298.04999 327.73999 Tm (This will help to ensure that )Tj 1 0 0 1 298.04999 310.73999 Tm (each person's needs are )Tj 1 0 0 1 298.04999 293.73999 Tm (identified and can be met. )Tj 1 0 0 1 482.10001 514.73999 Tm (07/12/2009)Tj 1 0 0 1 554.04999 514.73999 Tm (\240)Tj 1 0 0 1 35.5 274.48999 Tm (2)Tj 1 0 0 1 99.3 274.48999 Tm (7)Tj 1 0 0 1 201.55 274.48999 Tm (15)Tj 1 0 0 1 298.04999 274.48999 Tm (You must ensure that care )Tj 1 0 0 1 298.04999 257.48999 Tm (plans provide clear and up )Tj 1 0 0 1 298.04999 240.48999 Tm (to date instructions on how )Tj 1 0 0 1 298.04999 223.48999 Tm (each person's care needs )Tj 1 0 0 1 298.04999 206.48999 Tm (are to be met, recorded and )Tj 1 0 0 1 298.04999 189.48999 Tm (monitored. Information )Tj 1 0 0 1 298.04999 172.48999 Tm (recorded in care plans must )Tj 1 0 0 1 298.04999 155.48999 Tm (be relevant and appropriate. )Tj 1 0 0 1 298.04999 138.48999 Tm (All parts of the care plan )Tj 1 0 0 1 298.04999 121.49001 Tm (must be reviewed and )Tj 1 0 0 1 298.04999 104.49001 Tm (updated as appropriate. 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239.06999 Tm (4)Tj 1 0 0 1 96.15001 239.06999 Tm (30)Tj 1 0 0 1 202.5 239.06999 Tm (You must ensure that staff have had the training they need )Tj 1 0 0 1 202.5 224.48999 Tm (to care for people appropriately.)Tj ET endstream endobj 601 0 obj 1872 endobj 602 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (46)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 22.5 w 22.95 802.40997 m 560.45001 802.40997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 28.35001 799.08997 Tm (Helpline:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 28.35001 781.10999 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 28.35001 759.60004 Tm (Telephone:)Tj 0 Tr 1 0 0 1 95.88 759.60004 Tm ( 03000 616161)Tj 2 Tr 1 0 0 1 28.35001 739.60004 Tm (Email:)Tj 0 Tr 1 0 0 1 66.84 739.60004 Tm ( enquiries@cqc.org.uk)Tj 2 Tr 1 0 0 1 28.35001 719.60999 Tm (Web:)Tj 0 Tr 1 0 0 1 64.35001 719.60999 Tm (www.cqc.org.uk)Tj 1 0 0 1 28.35001 699.60999 Tm (\240)Tj 1 0 0 1 28.35001 679.60999 Tm (We want people to be able to access this information. If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 603 0 obj 4543 endobj 604 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 73.32001 w 31.2 470.10999 m 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We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 607 0 obj 5469 endobj 608 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 609 0 obj 9115 endobj 610 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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625.39001 Tm (honitonmanor@aol.com)Tj 1 0 0 1 34.05 602.56 Tm (Provider web address:)Tj 1 0 0 1 273.04999 602.56 Tm (oakdash@aol.com)Tj /T1_0 10 Tf 1 0 0 1 28.35001 583.60999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 109.98 w 32.32001 518.29999 m 564.76996 518.29999 l S 1 1 1 RG 64.32001 w 355.5 542.25 m 565.90002 542.25 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 497.54999 m 353.25 497.54999 l S 1 1 1 RG 355.5 497.54999 m 565.90002 497.54999 l S 0.95294 0.95294 0.95294 RG 31.2 474.72 m 353.25 474.72 l S 1 1 1 RG 355.5 474.72 m 565.90002 474.72 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13989 m 568.10004 486.13989 l S 28.99001 575.53998 m 568.10004 575.53998 l S 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13989 m 568.10004 486.13989 l S 28.99001 463.31 m 568.10004 463.31 l S 30.07001 576.60999 m 30.07001 462.22998 l S 354.37 576.60999 m 354.37 462.22998 l S 567.01996 576.60999 m 567.01996 462.22998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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281.29001 m 534.54999 281.29001 l S 536.79999 281.29001 m 565.90002 281.29001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 292.70001 m 568.10004 292.70001 l S 28.99001 269.87 m 568.10004 269.87 l S 30.07001 293.78 m 30.07001 268.80002 l S 316.37 293.78 m 316.37 268.80002 l S 347.66998 293.78 m 347.66998 268.80002 l S 379.01999 293.78 m 379.01999 268.80002 l S 410.31998 293.78 m 410.31998 268.80002 l S 441.66998 293.78 m 441.66998 268.80002 l S 473.01999 293.78 m 473.01999 268.80002 l S 504.31998 293.78 m 504.31998 268.80002 l S 535.66998 293.78 m 535.66998 268.80002 l S 567.01996 293.78 m 567.01996 268.80002 l S BT /T1_0 12 Tf 1 0 0 1 34.05 276.51999 Tm (Date of last inspection)Tj 1 0 0 1 328.20001 276.51999 Tm (0)Tj 1 0 0 1 359.53 276.51999 Tm (4)Tj 1 0 0 1 390.85999 276.51999 Tm (1)Tj 1 0 0 1 422.17999 276.51999 Tm (1)Tj 1 0 0 1 453.53 276.51999 Tm (2)Tj 1 0 0 1 484.85999 276.51999 Tm (0)Tj 1 0 0 1 516.17999 276.51999 Tm (0)Tj 1 0 0 1 547.52997 276.51999 Tm (8)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 258 m 565.90002 258 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 248.37 m 568.10004 248.37 l S 30.07001 249.45 m 30.07001 39.14999 l S 567.01996 249.45 m 567.01996 39.14999 l S 28.99001 267.62 m 568.10004 267.62 l S 28.99001 248.37 m 568.10004 248.37 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 268.70001 m 30.07001 247.28998 l S 567.01996 268.70001 m 567.01996 247.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 254.43999 Tm (Brief description of the )Tj 1 0 0 1 177.31 254.43999 Tm (care home)Tj 1 0 0 1 35.5 235.18999 Tm (Honiton Manor is registered to provide 24 hour nursing care for up to 22\ service users )Tj 1 0 0 1 35.5 218.19 Tm (who have needs relating to 'older people'.)Tj 1 0 0 1 35.5 201.19 Tm (\240)Tj 1 0 0 1 35.5 184.19 Tm (The two-storey home is an older style building situated on the main road\ into, and )Tj 1 0 0 1 35.5 167.19 Tm (quite close to, Honiton and the local amenities. It is on public transpo\ rt routes.)Tj 1 0 0 1 35.5 150.19 Tm (\240)Tj 1 0 0 1 35.5 133.19 Tm (There are eleven single bedrooms and five double bedrooms situated on th\ e ground )Tj 1 0 0 1 35.5 116.19 Tm (and first floors. One of the double bedrooms has an ensuite bathroom. A \ passenger lift )Tj 1 0 0 1 35.5 99.19 Tm (and a staircase link the floors.)Tj 1 0 0 1 35.5 82.19 Tm (\240)Tj 1 0 0 1 35.5 65.19 Tm (Communal space is made up of a large lounge and a dining room, both on t\ he ground )Tj 1 0 0 1 35.5 48.19 Tm (floor.)Tj ET endstream endobj 611 0 obj 1404 endobj 612 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 689.07996 l S 567.01996 795.47998 m 567.01996 689.07996 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 690.14996 m 568.10004 690.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (\240)Tj 1 0 0 1 33.25 766.46997 Tm (Outside there is access to a seating area and parking.)Tj 1 0 0 1 33.25 749.46997 Tm (\240)Tj 1 0 0 1 33.25 732.46997 Tm (Current charges are \243515.00 - \243675.00 per week. Charges do not inc\ lude items such )Tj 1 0 0 1 33.25 715.46997 Tm (as newspapers, toiletries, taxis etc.)Tj 1 0 0 1 33.25 698.46997 Tm (\240)Tj ET endstream endobj 613 0 obj 3597 endobj 614 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (This unannounced key inspection was due to be undertaken in November 200\ 9. It was )Tj 1 0 0 1 35.17 240.90001 Tm (bought forward as we had received some concerns about the quality of car\ e that )Tj 1 0 0 1 35.17 226.31998 Tm (people living here are receiving.)Tj 1 0 0 1 35.17 211.73999 Tm (\240)Tj 1 0 0 1 35.17 197.14998 Tm (During this visit we \(the commission\) spoke with or observed the major\ ity of people )Tj 1 0 0 1 35.17 182.56999 Tm (living here. We could not speak with some people because they have commu\ nication )Tj 1 0 0 1 35.17 167.98999 Tm (difficulties such as dementia. We looked closely at the care, services a\ nd )Tj 1 0 0 1 35.17 153.41 Tm (accommodation offered to four people living here. This is called case tr\ acking and helps )Tj 1 0 0 1 35.17 138.84 Tm (us to make a judgment about the standard of care overall, and helps us t\ o understand )Tj 1 0 0 1 35.17 124.25 Tm (the experiences of people who live here.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (We looked at the care and attention given by staff to these people and w\ e looked at )Tj 1 0 0 1 35.17 80.50999 Tm (their assessments and at their care planning records. We looked at the e\ nvironment in )Tj 1 0 0 1 35.17 65.93001 Tm (relation to their needs and how their health and personal care needs are\ met. We also )Tj ET endstream endobj 615 0 obj 2315 endobj 616 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 280.01999 w 32.32001 672.51996 m 566.71997 672.51996 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 531.38 m 568.91998 531.38 l S 31.2 814.72998 m 31.2 530.31 l S 567.84998 814.72998 m 567.84998 530.31 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (spoke with visitors to the home, with staff and with the manager and one\ of the )Tj 1 0 0 1 32.92 788.13995 Tm (owners. We visited the majority of bedrooms and saw all service and comm\ unal areas )Tj 1 0 0 1 32.92 773.56 Tm (of the home.)Tj 1 0 0 1 32.92 758.97998 Tm (\240)Tj 1 0 0 1 32.92 744.40002 Tm (We looked at records relating to accidents and incidents, staff training\ , staff )Tj 1 0 0 1 32.92 729.82001 Tm (recruitment, medication and at some policies.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (Prior to the inspection the owners sent us their Annual Quality Assuranc\ e Assessment )Tj 1 0 0 1 32.92 686.07996 Tm (\(AQAA\) which gave us information about the home and it's management an\ d about the )Tj 1 0 0 1 32.92 671.5 Tm (needs of people living here. This document asks for evidence in relation\ to what the )Tj 1 0 0 1 32.92 656.91998 Tm (home does well and what they think they can improve upon.)Tj 1 0 0 1 32.92 642.33997 Tm (\240)Tj 1 0 0 1 32.92 627.76001 Tm (In addition, we sent surveys to 8 people living here and 3 were returned\ . We sent 8 )Tj 1 0 0 1 32.92 613.17999 Tm (surveys to staff and 3 were returned. We sent 4 surveys to health and so\ cial care )Tj 1 0 0 1 32.92 598.60004 Tm (professionals and all were returned. Feedback and comments are included \ in the )Tj 1 0 0 1 32.92 584.01996 Tm (report.)Tj 1 0 0 1 32.92 569.44 Tm (\240)Tj 1 0 0 1 32.92 554.85999 Tm (During this inspection evidence was taken under the Police and Criminal \ Evidence Act )Tj 1 0 0 1 32.92 540.27997 Tm (and this has been considered under our enforcement procedures.)Tj ET endstream endobj 617 0 obj 6453 endobj 618 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 64.32001 w 32.32001 741.65997 m 566.71997 741.65997 l S 20.58 w 32.7 696.95996 m 569.34998 696.95996 l S 93.48 w 33.82001 637.67999 m 568.21997 637.67999 l S 20.58 w 33.45 578.40002 m 570.10004 578.40002 l S 501.84 w 34.57001 314.94998 m 568.96997 314.94998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 708.38 m 568.91998 708.38 l S 31.2 776.02997 m 31.2 707.29999 l S 31.2 708.38 m 569.34998 708.38 l S 32.7 685.54999 m 569.34998 685.54999 l S 31.62 685.54999 m 570.41998 685.54999 l S 31.62 589.82001 m 570.41998 589.82001 l S 33.45 566.98999 m 570.10004 566.98999 l S 33.45 589.82001 m 570.10004 589.82001 l S 32.37 566.98999 m 571.16998 566.98999 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 686.63 m 32.7 588.73999 l S 33.45 568.07001 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 707.29999 l S 569.34998 686.63 m 569.34998 588.73999 l S 570.10004 568.07001 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (This home is warm, clean and comfortable. Staff are described as nice an\ d caring and )Tj 1 0 0 1 35.17 744.17999 Tm (as doing their best. The home has a lot of nursing equipment such as adj\ ustable beds )Tj 1 0 0 1 35.17 729.60004 Tm (and pressure relieving mattresses. People really enjoy the food served h\ ere which is )Tj 1 0 0 1 35.17 715.01996 Tm (nutritious and offers variety. )Tj /T1_0 10 Tf 1 0 0 1 568.96997 740.10999 Tm (\240)Tj 1 0 0 1 31.2 694.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 692.19 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 695.40997 Tm (\240)Tj 1 0 0 1 31.2 636.13 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 669.35999 Tm (Since the last inspection the programme of redecoration has continued. W\ e saw that a )Tj 1 0 0 1 36.67 654.77997 Tm (window was being replaced and that the front door is now secured with a \ key pad type )Tj 1 0 0 1 36.67 640.20001 Tm (lock.)Tj 1 0 0 1 36.67 625.62 Tm (The home has employed a part time activities co-ordinator and this perso\ n's efforts are )Tj 1 0 0 1 36.67 611.03998 Tm (having an impact for some people.)Tj 1 0 0 1 36.67 596.45996 Tm (The Requirement made at the last inspection in relation to medicines has\ been met. )Tj /T1_0 10 Tf 1 0 0 1 570.46997 636.13 Tm (\240)Tj 1 0 0 1 31.2 576.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 573.63 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 313.38998 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 550.79999 Tm (This home does not have a registered manager and is not being sufficient\ ly well )Tj 1 0 0 1 37.42 536.21997 Tm (managed. This has resulted in people's health and welfare needs not alwa\ ys being )Tj 1 0 0 1 37.42 521.64001 Tm (assessed or met. The care planning and communicating systems in place ar\ e not )Tj 1 0 0 1 37.42 507.06 Tm (sufficiently robust to ensure that care staff have the information they \ need about )Tj 1 0 0 1 37.42 492.47998 Tm (people's care needs and how these should be met.)Tj 1 0 0 1 37.42 477.89996 Tm (\240)Tj 1 0 0 1 37.42 463.31998 Tm (Staff are well intentioned but are not always on duty in sufficient numb\ ers, and do not )Tj 1 0 0 1 37.42 448.73999 Tm (always have the support they need, to meet people's needs. On one night \ there was )Tj 1 0 0 1 37.42 434.16 Tm (not a waking Registered Nurse on duty. Staff are not recruited in a robu\ st way and this )Tj 1 0 0 1 37.42 419.57999 Tm (means that people are at risk of being cared for by inappropriate staff.\ )Tj 1 0 0 1 37.42 405 Tm (\240)Tj 1 0 0 1 37.42 390.41998 Tm (People are not always treated with dignity and their rights to make choi\ ces or to be )Tj 1 0 0 1 37.42 375.84 Tm (engaged and sociable are not always supported. Some people's sense of se\ lf and )Tj 1 0 0 1 37.42 361.25998 Tm (personal identity is in danger of being eroded by a system that is not a\ lways person )Tj 1 0 0 1 37.42 346.67999 Tm (centred and is sometimes institutionalised.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Complaints have been made to the commission by some people. They complai\ n that )Tj 1 0 0 1 37.42 302.94 Tm (the home is not well managed and the quality of care has declined. These\ concerns are )Tj 1 0 0 1 37.42 288.35999 Tm (being investigated by the local safeguarding team. This is the second sa\ feguarding )Tj 1 0 0 1 37.42 273.78 Tm (alert that has been made since the last inspection. Whilst this investig\ ation is ongoing, )Tj 1 0 0 1 37.42 259.20001 Tm (admissions to this home via health or social care services have been sus\ pended by )Tj 1 0 0 1 37.42 244.62 Tm (Adult and Community Services.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Staff training is not up to date and some specialist training is being d\ esignated to )Tj 1 0 0 1 37.42 200.87999 Tm (people who are not qualified or experienced to carry this out.)Tj 1 0 0 1 37.42 186.3 Tm (\240)Tj 1 0 0 1 37.42 171.72 Tm (Some working practices and systems are not ensuring people's safety. Thi\ s includes )Tj 1 0 0 1 37.42 157.14 Tm (moving and handling people, ensuring windows are restricted to prevent a\ ccidental )Tj 1 0 0 1 37.42 142.56 Tm (falls, the maintenance of equipment and risk assessments and actions in \ relation to the )Tj 1 0 0 1 37.42 127.98 Tm (use of restraint. Systems are not robust enough to ensure that it is cle\ ar which staff )Tj 1 0 0 1 37.42 113.40001 Tm (have received mandatory training and which have not. The system for reco\ rding and )Tj 1 0 0 1 37.42 98.82001 Tm (monitoring accidents and incidents is not being used to help prevent fur\ ther accidents.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (The commission have not been kept informed in relation to all incidents,\ accidents and )Tj ET endstream endobj 619 0 obj 2243 endobj 620 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 148.8 w 34.57001 738.13 m 568.96997 738.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 662.60004 m 571.16998 662.60004 l S 33.45 814.72998 m 33.45 661.52997 l S 570.10004 814.72998 m 570.10004 661.52997 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (deaths in the home, as we should be so that we can monitor this type of \ activity in the )Tj 1 0 0 1 35.17 788.13995 Tm (home.)Tj 1 0 0 1 35.17 773.56 Tm (\240)Tj 1 0 0 1 35.17 758.97998 Tm (Statutory Requirement Notices have been issued to the registered owners \ of this )Tj 1 0 0 1 35.17 744.40002 Tm (service. These Notices inform the providers that they have failed to com\ ply with the )Tj 1 0 0 1 35.17 729.82001 Tm (Care Home Regulations 2001 in relation to planning people's care and in \ relation to )Tj 1 0 0 1 35.17 715.23999 Tm (meeting people's health and welfare needs. The Statutory Requirement Not\ ices tell the )Tj 1 0 0 1 35.17 700.65997 Tm (providers what they must do and gives them dates by when the failures id\ entified must )Tj 1 0 0 1 35.17 686.07996 Tm (be addressed.)Tj 1 0 0 1 35.17 671.5 Tm (\240)Tj 1 0 0 1 28.35001 648.03998 Tm (\240)Tj 1 0 0 1 28.35001 628.04999 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 628.04999 Tm (care home)Tj 1 0 0 1 480.03998 628.04999 Tm ( is taking )Tj 1 0 0 1 28.35001 610.54999 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 590.56 Tm (\240)Tj 1 0 0 1 28.35001 570.56 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 570.56 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 550.56 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 550.56 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 530.57001 Tm (order line 0870 240 7535.)Tj ET endstream endobj 621 0 obj 1804 endobj 622 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 623 0 obj 5905 endobj 624 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (Some people move into this home without having their needs fully assesse\ d and )Tj 1 0 0 1 36.62 341.25 Tm (without agreement from the funding authority. This means that people can\ not be sure )Tj 1 0 0 1 36.62 323.75998 Tm (that their needs will be met in an appropriate way or that they will be \ staying in this )Tj 1 0 0 1 36.62 306.25998 Tm (home. )Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (In surveys two out of three people who live here told us that they had t\ he information )Tj 1 0 0 1 36.57001 216.78 Tm (they needed to decide if this was the home for them. In addition, two ou\ t of three )Tj 1 0 0 1 36.57001 199.28 Tm (health care professionals say that the home's assessment arrangements us\ ually )Tj 1 0 0 1 36.57001 181.78998 Tm (ensure that accurate information is gathered and that the right service \ is planned for )Tj 1 0 0 1 36.57001 164.28999 Tm (people. One health care professional told us that this always happens.)Tj 1 0 0 1 36.57001 146.78999 Tm (\240)Tj 1 0 0 1 36.57001 129.3 Tm (We were told that the home had admitted two people to this home without \ an )Tj 1 0 0 1 36.57001 111.8 Tm (assessment by and without the agreement of the funding authority. When w\ e looked )Tj 1 0 0 1 36.57001 94.31 Tm (at records we found these people had been admitted from a residential ho\ me owned )Tj ET endstream endobj 625 0 obj 2644 endobj 626 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 336.30002 w 34.60001 643.26001 m 562.53998 643.26001 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 314.92999 w 33.47 631.44 m 563.65997 631.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 471.78 l S 564.78998 791.10999 m 564.78998 471.78 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 472.85999 m 565.87 472.85999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (by the owners of this home.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We spoke with staff who told us that one of these people had moved here \ because )Tj 1 0 0 1 34.32001 726.60999 Tm (they have nursing needs and therefore need their care to be planned and \ delivered by )Tj 1 0 0 1 34.32001 709.10999 Tm (registered nurses.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We looked at the records of one of these people. We found that an assess\ ment of their )Tj 1 0 0 1 34.32001 656.63 Tm (nursing needs had not taken place prior to their admission, or since the\ ir admission. )Tj 1 0 0 1 34.32001 639.13 Tm (We found that all assessments in their records have been carried out in \ the home they )Tj 1 0 0 1 34.32001 621.63 Tm (used to live in.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (We could not speak with this person about their feelings about the move \ as they have )Tj 1 0 0 1 34.32001 569.14996 Tm (communication difficulties. We spoke with the relative of another person\ living here. )Tj 1 0 0 1 34.32001 551.64996 Tm (They told us that they had looked around the home and at the bedroom the\ person )Tj 1 0 0 1 34.32001 534.14996 Tm (would move into. They were able to ask questions about the home before d\ eciding this )Tj 1 0 0 1 34.32001 516.65997 Tm (was the right home. However, we noted that this person's care record did\ not contain )Tj 1 0 0 1 34.32001 499.16 Tm (pre admission information from health and social care professionals as i\ t should.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj ET endstream endobj 627 0 obj 5782 endobj 628 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 403.25 m 562.53998 403.25 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 119.35001 w 33.47 392 m 563.65997 392 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 330.12 l S 564.78998 453.88 m 564.78998 330.12 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 331.20001 m 565.87 331.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (Peoples' medicines are safely managed. However, some people are being pu\ t at risk )Tj 1 0 0 1 36.62 375.25 Tm (because their health and welfare needs are not being met. People do not \ have their )Tj 1 0 0 1 36.62 357.75998 Tm (care planned in a person centred way that treats them as individuals and\ are not )Tj 1 0 0 1 36.62 340.25998 Tm (always treated with dignity. )Tj 1 0 0 1 28.35001 315.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.3 w 34.60001 193.67999 m 562.53998 193.67999 l S 1 1 1 RG 22.5 w 32.35001 296.32999 m 564.78998 296.32999 l S 201.92998 w 33.47 181.87 m 563.65997 181.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 283.95999 m 565.87 283.95999 l S 32.35001 285.04001 m 32.35001 78.70001 l S 564.78998 285.04001 m 564.78998 78.70001 l S 32.35001 283.95999 m 564.78998 283.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.26999 Tm (In surveys people living here told us they usually get the care and supp\ ort they need )Tj 1 0 0 1 36.57001 250.78 Tm (and that they always or usually get the medical support they need.)Tj 1 0 0 1 36.57001 233.28 Tm (\240)Tj 1 0 0 1 36.57001 215.78998 Tm (Two health care professionals told us that people's health care needs ar\ e always )Tj 1 0 0 1 36.57001 198.28998 Tm (properly monitored and one told us this usually happens. Two also said t\ hat the staff )Tj 1 0 0 1 36.57001 180.78998 Tm (at the home seek advice and act on it to improve well being, and one sai\ d that this )Tj 1 0 0 1 36.57001 163.3 Tm (sometimes happened. Comments from health care professionals include that\ staff act )Tj 1 0 0 1 36.57001 145.8 Tm (promptly to get medical help for people who need it and that some people\ have )Tj 1 0 0 1 36.57001 128.31 Tm (blossomed since living here.)Tj 1 0 0 1 36.57001 110.81 Tm (\240)Tj 1 0 0 1 36.57001 93.31 Tm (We looked in depth at the care plans of four people living here. We also\ looked at )Tj ET endstream endobj 629 0 obj 5378 endobj 630 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (some others. We found that each person has a plan of care and that these\ contain a )Tj 1 0 0 1 34.32001 761.60004 Tm (large number and range of documents relating to care needs. However, the\ se )Tj 1 0 0 1 34.32001 744.10999 Tm (documents were not person centred, are sometimes contradictory and do no\ t always )Tj 1 0 0 1 34.32001 726.60999 Tm (provide care staff with the detailed information that they need to meet \ people's needs.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (For example one person that we case tracked has been admitted from the o\ wners' )Tj 1 0 0 1 34.32001 674.12 Tm (residential home. This person's care plan is the care plan from that hom\ e. Staff told us )Tj 1 0 0 1 34.32001 656.63 Tm (that the reason this person was admitted to this home was because staff \ believe that )Tj 1 0 0 1 34.32001 639.13 Tm (they need the 24 hour care of nurses. However, nurses have not devised a\ care plan )Tj 1 0 0 1 34.32001 621.63 Tm (as to how this person's nursing needs are to be met. In addition, inform\ ation recorded )Tj 1 0 0 1 34.32001 604.14001 Tm (in the daily notes from the residential home has not been followed up. B\ efore being )Tj 1 0 0 1 34.32001 586.64001 Tm (admitted to this home, it was recorded that this person has a urinary ca\ theter, is )Tj 1 0 0 1 34.32001 569.14996 Tm (prone to urinary tract infections and needs encouragement to drink. Two \ days before )Tj 1 0 0 1 34.32001 551.64996 Tm (being admitted it is recorded that this person had very strong and dark \ urine which )Tj 1 0 0 1 34.32001 534.14996 Tm (means this person may not be drinking enough fluid. This person has live\ d in this care )Tj 1 0 0 1 34.32001 516.65997 Tm (home for approximately 6 weeks and the care notes have not mentioned thi\ s person's )Tj 1 0 0 1 34.32001 499.16 Tm (urine. We asked staff about this and they told us that the night staff e\ mpty the )Tj 1 0 0 1 34.32001 481.66998 Tm (catheter bag and that they didn't know how much urine this person passed\ or what )Tj 1 0 0 1 34.32001 464.16998 Tm (colour it is.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked to see how much this person drinks in a day because the reside\ ntial care )Tj 1 0 0 1 34.32001 411.67999 Tm (home instructions state that they should be encouraged to drink to preve\ nt urinary )Tj 1 0 0 1 34.32001 394.19 Tm (tract infections. We saw records that show this person drinks between 20\ 0mls and )Tj 1 0 0 1 34.32001 376.69 Tm (1050mls in a day. The records do not contain instructions about how much\ this person )Tj 1 0 0 1 34.32001 359.19 Tm (should drink in a day. We asked carers how much this person should drink\ to keep )Tj 1 0 0 1 34.32001 341.70001 Tm (them healthy and they thought that this would be about 1000mls. We asked\ carers if )Tj 1 0 0 1 34.32001 324.20001 Tm (they knew how much this person had drunk in the past days and they said \ they did )Tj 1 0 0 1 34.32001 306.70999 Tm (not because the nurse totals up the amount drunk. A nurse has reviewed t\ he records )Tj 1 0 0 1 34.32001 289.20999 Tm (kept about this person and the amount they have drunk. They record, in d\ ifferent )Tj 1 0 0 1 34.32001 271.70999 Tm (places in the care plan, that they have drunk a fair amount, small amoun\ t and a good )Tj 1 0 0 1 34.32001 254.22 Tm (amount. However, these reviews do not appear to have taken into account \ the days )Tj 1 0 0 1 34.32001 236.72 Tm (when this person has only drunk 200mls, 350mls and 400mls. We have calcu\ lated )Tj 1 0 0 1 34.32001 219.23 Tm (that this person, according to their weight, should have at least 1880ml\ s to drink each )Tj 1 0 0 1 34.32001 201.73 Tm (day. We spoke with the temporary manager about how much people should dr\ ink. She )Tj 1 0 0 1 34.32001 184.23 Tm (told us she knows there is a calculation to work this out, but does not \ know what it is. )Tj 1 0 0 1 34.32001 166.73999 Tm (We also noted that records show that this person does not have a drink b\ etween 6pm )Tj 1 0 0 1 34.32001 149.23999 Tm (and 8 or 9am. This is a very long time for someone who has a catheter an\ d is prone to )Tj 1 0 0 1 34.32001 131.75 Tm (urinary tract infections.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (We observed this person on the day of this inspection. They had numerous\ drinks put )Tj ET endstream endobj 631 0 obj 5195 endobj 632 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (in front of them by members of staff. No encouragement to drink was give\ n by staff, )Tj 1 0 0 1 34.32001 761.60004 Tm (but was given by their wife. we would estimate that this person drank ap\ proximately )Tj 1 0 0 1 34.32001 744.10999 Tm (50mls between 10am and 1pm.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We also saw that other people do not have enough to drink.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We saw in care plans that people are assessed to see if they are at risk\ of developing )Tj 1 0 0 1 34.32001 656.63 Tm (pressure sores. We saw that people we had case tracked are at risk. Thes\ e people are )Tj 1 0 0 1 34.32001 639.13 Tm (cared for on pressure relieving mattresses and cushions as is good pract\ ice. Some )Tj 1 0 0 1 34.32001 621.63 Tm (people are also nursed on adjustable beds which is also good practice. W\ e were told )Tj 1 0 0 1 34.32001 604.14001 Tm (that one person has developed a pressure sore since coming to live here \ and that one )Tj 1 0 0 1 34.32001 586.64001 Tm (person came to the home having already developed a pressure sore. We loo\ ked at )Tj 1 0 0 1 34.32001 569.14996 Tm (some pressure relieving equipment. We found one mattress had been set to\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (maximum pressure indicating that the person using this mattress is heavy\ . When we )Tj 1 0 0 1 34.32001 534.14996 Tm (looked in care records we found that this person is very light. We asked\ staff how they )Tj 1 0 0 1 34.32001 516.65997 Tm (work out the pressure that the mattress should be set to. One person sai\ d they did )Tj 1 0 0 1 34.32001 499.16 Tm (not know, another said the person setting it up does it. We looked in ca\ re plans, in )Tj 1 0 0 1 34.32001 481.66998 Tm (people's bedrooms and on the mattress motors to see if staff have access\ to )Tj 1 0 0 1 34.32001 464.16998 Tm (instructions about the pressure each mattress should be set at. We did n\ ot find any )Tj 1 0 0 1 34.32001 446.66998 Tm (instructions.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We saw in care plans that some people are at risk of malnutrition. One p\ erson we case )Tj 1 0 0 1 34.32001 394.19 Tm (tracked is losing weight. The GP has been informed. However, the recomme\ ndations )Tj 1 0 0 1 34.32001 376.69 Tm (made by the specialist nutritional tool used \(MUST\) have not been foll\ owed. According )Tj 1 0 0 1 34.32001 359.19 Tm (to this person's level of risk they should be having specific drinks to \ supplement their )Tj 1 0 0 1 34.32001 341.70001 Tm (calorie intake. Records show that these are given intermittently and not\ routinely. We )Tj 1 0 0 1 34.32001 324.20001 Tm (asked staff if this person has supplement drinks and they said no.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We noted in another person's records that they had been having loose bow\ el motions )Tj 1 0 0 1 34.32001 271.70999 Tm (and saw and heard from a relative that they had been off their food. Rec\ ords also )Tj 1 0 0 1 34.32001 254.22 Tm (show that this person has been what is described as 'grumpy'. This perso\ n has been )Tj 1 0 0 1 34.32001 236.72 Tm (weighed weekly. Although the most recent weight shows a weight gain, the\ general )Tj 1 0 0 1 34.32001 219.23 Tm (trend is that this person is losing weight. There was no record to show \ that this is )Tj 1 0 0 1 34.32001 201.73 Tm (being addressed. Staff are not keeping records of what this person eats \ and drinks. A )Tj 1 0 0 1 34.32001 184.23 Tm (nurse had recorded that they had reviewed this care plan but had not tak\ en any action )Tj 1 0 0 1 34.32001 166.73999 Tm (to address these health issues. This means that this person's health is \ not being )Tj 1 0 0 1 34.32001 149.23999 Tm (monitored appropriately and might result in a delay in appropriate actio\ n being taken.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (Prior to this inspection, the owners provided us with an updated improve\ ment plan in )Tj 1 0 0 1 34.32001 96.75 Tm (relation to requirements made at the last inspection about meeting peopl\ e's nutritional )Tj ET endstream endobj 633 0 obj 5376 endobj 634 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs. This told us that the completion of the nutritional risk assessme\ nt tool \(MUST\) )Tj 1 0 0 1 34.32001 761.60004 Tm (and for taking action if risk is identified has been designated to the c\ atering manager. )Tj 1 0 0 1 34.32001 744.10999 Tm (This person, along with other staff in the home, has received training i\ n relation to )Tj 1 0 0 1 34.32001 726.60999 Tm (nutrition from a company that supplies nutritional supplements. However,\ this does )Tj 1 0 0 1 34.32001 709.10999 Tm (not qualify them to carry out these assessments or to determine the acti\ ons that )Tj 1 0 0 1 34.32001 691.62 Tm (should be taken.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (Another care plan recorded that one person stays in bed all day and does\ not get )Tj 1 0 0 1 34.32001 639.13 Tm (dressed. It states the reason for this as them being immobile and having\ contractures )Tj 1 0 0 1 34.32001 621.63 Tm (of their legs. Records do not include evidence that consideration has be\ en given, or )Tj 1 0 0 1 34.32001 604.14001 Tm (that actions have been taken, to make arrangements or find moving and ha\ ndling )Tj 1 0 0 1 34.32001 586.64001 Tm (equipment that might allow this person to move out of their bed.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We looked at other records relating to people with dementia. Care plans \ state for )Tj 1 0 0 1 34.32001 534.14996 Tm (example, that some people have a poor mental state and reduced powers of\ )Tj 1 0 0 1 34.32001 516.65997 Tm (comprehension. However, care plans do not provide a plan as to how these\ people's )Tj 1 0 0 1 34.32001 499.16 Tm (mental health and welfare needs are to be addressed or met. In addition,\ it has been )Tj 1 0 0 1 34.32001 481.66998 Tm (agreed on three people's behalf, who are described as confused or having\ dementia, )Tj 1 0 0 1 34.32001 464.16998 Tm (that they would like to get them up as early as 6am. One of these people\ has an )Tj 1 0 0 1 34.32001 446.66998 Tm (illness the symptoms of which include stiffness, especially in the morni\ ng and fatigue. )Tj 1 0 0 1 34.32001 429.17999 Tm (These symptoms do not seem to have been considered in the decision to ge\ t them up )Tj 1 0 0 1 34.32001 411.67999 Tm (early.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We observed that one person is at high risk of choking as they have diff\ iculty )Tj 1 0 0 1 34.32001 359.19 Tm (swallowing. This person was referred to the Speech and Language Therapis\ t \(SALT\) )Tj 1 0 0 1 34.32001 341.70001 Tm (some time ago. However, a visiting health care professional observed tha\ t staff were )Tj 1 0 0 1 34.32001 324.20001 Tm (not following the guidance given by the SALT. They asked this specialist\ to visit again. )Tj 1 0 0 1 34.32001 306.70999 Tm (Instructions were left for staff to follow as to how this person is to b\ e supported to )Tj 1 0 0 1 34.32001 289.20999 Tm (eat. We saw that some of this guidance is being put into practice. Howev\ er, we also )Tj 1 0 0 1 34.32001 271.70999 Tm (saw that some is not. For example, we saw that nurses saw a visitor offe\ ring this )Tj 1 0 0 1 34.32001 254.22 Tm (person a chocolate covered wafer. They did not explain to the visitor th\ at this might )Tj 1 0 0 1 34.32001 236.72 Tm (cause problems for this person's swallowing. We saw this person in their\ wheelchair, )Tj 1 0 0 1 34.32001 219.23 Tm (leaning over to one side after lunch. This person is meant to sit up for\ 30 mins after )Tj 1 0 0 1 34.32001 201.73 Tm (eating. We saw that a member of staff put this person to bed soon after \ lunch, lying )Tj 1 0 0 1 34.32001 184.23 Tm (down. We asked staff about how this person is supported to eat and not c\ hoke. They )Tj 1 0 0 1 34.32001 166.73999 Tm (told us what they knew, but did not know that this person should be sat \ up for 30mins )Tj 1 0 0 1 34.32001 149.23999 Tm (after they had eaten. Staff told us this person has a pureed diet which \ complies with )Tj 1 0 0 1 34.32001 131.75 Tm (the SALT instructions. They also told us that they give this person cake\ and biscuits, )Tj 1 0 0 1 34.32001 114.25 Tm (which puts this person at risk of choking. The care plan does not contai\ n instructions )Tj 1 0 0 1 34.32001 96.75 Tm (for staff about what to do if this person chokes. One carer told us they\ would use their )Tj ET endstream endobj 635 0 obj 5253 endobj 636 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (common sense and try a grab and thrust movement. A nurse told us she hop\ ed that )Tj 1 0 0 1 34.32001 761.60004 Tm (staff would know to call a nurse or 999. This lack of instruction means \ that there may )Tj 1 0 0 1 34.32001 744.10999 Tm (be a delay in this person getting appropriate help.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We asked the manager how staff have been given information about this pe\ rson's )Tj 1 0 0 1 34.32001 691.62 Tm (needs and risk of choking since the most recent visit by the SALT. We we\ re told that )Tj 1 0 0 1 34.32001 674.12 Tm (the nurses had been told about the special requirements for this person,\ and the )Tj 1 0 0 1 34.32001 656.63 Tm (nurses were named, and that they give this information to the carers. We\ saw from )Tj 1 0 0 1 34.32001 639.13 Tm (the duty rota that one of these nurses had been on sick leave over this \ period. The )Tj 1 0 0 1 34.32001 621.63 Tm (manager confirmed this adding that the nurses already knew about the adv\ ice. We )Tj 1 0 0 1 34.32001 604.14001 Tm (reminded her that the SALT referral was made again because staff were no\ t following )Tj 1 0 0 1 34.32001 586.64001 Tm (the advice given, and this was putting this person at risk of choking.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We saw in the improvement plan provided by the owners that staff have ha\ d training )Tj 1 0 0 1 34.32001 534.14996 Tm (from the SALT in supporting people who have difficulties swallowing. Thi\ s document )Tj 1 0 0 1 34.32001 516.65997 Tm (also tells us that further updates will be given by the catering manager\ . This person is )Tj 1 0 0 1 34.32001 499.16 Tm (not qualified to do this and this is not good practice. We have checked \ with the SALT )Tj 1 0 0 1 34.32001 481.66998 Tm (and they have told us that they are happy to provide further training if\ needed.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We saw that many people living here have mobility problems. We checked c\ are plans )Tj 1 0 0 1 34.32001 429.17999 Tm (to see if people had had their moving and handling needs assessed. We fo\ und that )Tj 1 0 0 1 34.32001 411.67999 Tm (some people had not had these needs assessed. We found another that was \ dated )Tj 1 0 0 1 34.32001 394.19 Tm (April 2007 which had not been reviewed or updated since that time. Care \ plans give )Tj 1 0 0 1 34.32001 376.69 Tm (very general instructions for care staff such as 'needs hoist'. They did\ not specify the )Tj 1 0 0 1 34.32001 359.19 Tm (type of hoist to be used or the size of sling. We spoke to a nurse about\ how staff know )Tj 1 0 0 1 34.32001 341.70001 Tm (which hoist and sling to use. The nurse told us that if a person is on t\ he ground floor )Tj 1 0 0 1 34.32001 324.20001 Tm (they use the hoist that is on that floor and that carers make a judgment\ about what )Tj 1 0 0 1 34.32001 306.70999 Tm (size sling to use. This means that carers are not being supported to ens\ ure that they )Tj 1 0 0 1 34.32001 289.20999 Tm (use the appropriate equipment for each person.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (We also noted that the hoist is often used to help people who have been \ incontinent of )Tj 1 0 0 1 34.32001 236.72 Tm (urine. We saw that people share slings which does not help to prevent th\ e spread of )Tj 1 0 0 1 34.32001 219.23 Tm (infection and indicates that care is de-personalised.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Care plans in this home are in two parts. There is a larger comprehensiv\ e part which )Tj 1 0 0 1 34.32001 166.73999 Tm (contains details relating to the person and the plan of care. There is a\ lso a day to day )Tj 1 0 0 1 34.32001 149.23999 Tm (record which the manager told us is what carers use. Instructions in the\ se smaller )Tj 1 0 0 1 34.32001 131.75 Tm (records contain task orientated information such as needs feeding, hoist\ , weekly )Tj 1 0 0 1 34.32001 114.25 Tm (weight and on fluid chart. These are not person centred and do not give \ care staff the )Tj 1 0 0 1 34.32001 96.75 Tm (information they need to provide individualised care based on each perso\ n's individual )Tj ET endstream endobj 637 0 obj 4999 endobj 638 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs and preferences.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (Carers told us they do not tend to read care plans, although they do wri\ te in them. For )Tj 1 0 0 1 34.32001 726.60999 Tm (example they record fluid and food intake if people need to have this re\ corded. We )Tj 1 0 0 1 34.32001 709.10999 Tm (found that entries made by staff include impersonal comments such as pad\ changed, )Tj 1 0 0 1 34.32001 691.62 Tm (repositioned, soaking wet bed, usual day and nothing new. This type of l\ anguage is an )Tj 1 0 0 1 34.32001 674.12 Tm (indicator that the provision of care is task orientated and de personali\ sed.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (We asked how staff get the information they need about people and their \ needs if they )Tj 1 0 0 1 34.32001 621.63 Tm (do not read care plans. They told us they know people, or get to know th\ em. They say )Tj 1 0 0 1 34.32001 604.14001 Tm (they do not get a handover of information when they come on duty, that o\ nly the )Tj 1 0 0 1 34.32001 586.64001 Tm (nurse gets this. They say they start work straight away. They know who n\ eeds getting )Tj 1 0 0 1 34.32001 569.14996 Tm (up and who needs breakfast. We asked the temporary manager how it is ens\ ure that )Tj 1 0 0 1 34.32001 551.64996 Tm (carers have the information they need to care for people and were told t\ hat she would )Tj 1 0 0 1 34.32001 534.14996 Tm (hope nurses give this. This means there is not a robust system in place \ to ensure that )Tj 1 0 0 1 34.32001 516.65997 Tm (care staff have the information and guidance they need to ensure that pe\ ople's needs )Tj 1 0 0 1 34.32001 499.16 Tm (are met.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We saw that care plans are reviewed by nurses. However, we noted that de\ spite )Tj 1 0 0 1 34.32001 446.66998 Tm (changes in people's conditions that there were no changes to the plans o\ f care. We )Tj 1 0 0 1 34.32001 429.17999 Tm (also noted that reviews of care plans do not record what information has\ been used to )Tj 1 0 0 1 34.32001 411.67999 Tm (make the nursing decisions.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (The pharmacist inspector inspected the way that medicines are managed in\ this home. )Tj 1 0 0 1 34.32001 359.19 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 341.70001 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 324.20001 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 306.70999 Tm (were told that sometimes people can look after and take their own medici\ nes. There )Tj 1 0 0 1 34.32001 289.20999 Tm (are not any people living in the home at the moment who do this, and peo\ ple are )Tj 1 0 0 1 34.32001 271.70999 Tm (given their medicines by nursing staff.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (Medicines are stored safely for the protection of people in the home. Th\ ere are )Tj 1 0 0 1 34.32001 219.23 Tm (suitable arrangements for controlled drugs and any medicines requiring c\ old-storage.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Records are kept of medicines received into the home, and of any unwante\ d medicines )Tj 1 0 0 1 34.32001 166.73999 Tm (that are sent for destruction. Records are kept of medicines that are gi\ ven to people, )Tj 1 0 0 1 34.32001 149.23999 Tm (which helps to show that people receive their medicines as prescribed by\ the doctor. If )Tj 1 0 0 1 34.32001 131.75 Tm (a regularly prescribed dose is omitted, then a reason for this is record\ ed, as is good )Tj 1 0 0 1 34.32001 114.25 Tm (practice. Usually if a variable dose is prescribed there are clear recor\ ds to show how )Tj 1 0 0 1 34.32001 96.75 Tm (much is given, and this too is good practice.)Tj ET endstream endobj 639 0 obj 4862 endobj 640 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 686.21997 w 34.60001 468.30002 m 562.53998 468.30002 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 664.84998 w 33.47 456.47998 m 563.65997 456.47998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 121.86 l S 564.78998 791.10999 m 564.78998 121.86 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 122.93001 m 565.87 122.93001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We looked at some people's care plans to see what information is recorde\ d about their )Tj 1 0 0 1 34.32001 744.10999 Tm (medicines. We found written permission from the doctor to crush someone'\ s tablets )Tj 1 0 0 1 34.32001 726.60999 Tm (before giving. Staff had not asked if other forms of the same medicines \ are available, )Tj 1 0 0 1 34.32001 709.10999 Tm (such as soluble tablets or liquids, to make it easier for people to take\ . We found clear )Tj 1 0 0 1 34.32001 691.62 Tm (guidance for staff on when to administer medication that was prescribed \ to be given )Tj 1 0 0 1 34.32001 674.12 Tm ('when required'. This helps to show that people receive their medicines \ in the way )Tj 1 0 0 1 34.32001 656.63 Tm (their doctor intended for them.)Tj 1 0 0 1 34.32001 639.13 Tm (\240)Tj 1 0 0 1 34.32001 621.63 Tm (We looked at how people's privacy and dignity is maintained. We heard pe\ ople being )Tj 1 0 0 1 34.32001 604.14001 Tm (called by their preferred names and some people were able to tell us the\ y wear their )Tj 1 0 0 1 34.32001 586.64001 Tm (own clothes. We saw staff discreetly helping some people go to the toile\ t. However, )Tj 1 0 0 1 34.32001 569.14996 Tm (we also saw one person trying to attract the attention of staff who walk\ ed past or said )Tj 1 0 0 1 34.32001 551.64996 Tm ('hang on' as they walked past and did not come back. We heard one person\ saying no )Tj 1 0 0 1 34.32001 534.14996 Tm (repeatedly and we heard a carer saying 'yes, yes, yes' in a mocking fash\ ion.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We saw in the care plans of two people that they like to be or are washe\ d, shaved, )Tj 1 0 0 1 34.32001 481.66998 Tm (have their hair brushed and dressed whilst sitting on the commode. This \ is not a )Tj 1 0 0 1 34.32001 464.16998 Tm (dignified way to provide care. In addition a record of names of people w\ ho had taken )Tj 1 0 0 1 34.32001 446.66998 Tm (a bath is kept in the communal bathroom. This indicates an institutional\ approach to )Tj 1 0 0 1 34.32001 429.17999 Tm (people's personal care needs and to their confidentiality.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (We saw one person being hoisted to be taken to the toilet. When raised o\ ut of their )Tj 1 0 0 1 34.32001 376.69 Tm (seat there was a strong smell of urine. After they left the lounge, the \ smell persisted. )Tj 1 0 0 1 34.32001 359.19 Tm (We smelt the chair and found that the smell was coming from the fabric o\ f the chair, )Tj 1 0 0 1 34.32001 341.70001 Tm (and from the pressure relieving cushion on the chair. When staff returne\ d they put )Tj 1 0 0 1 34.32001 324.20001 Tm (this person back onto the chair. Each time this person shifted their wei\ ght in their )Tj 1 0 0 1 34.32001 306.70999 Tm (chair, there was an unpleasant odour of stale urine released.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj 1 0 0 1 34.32001 271.70999 Tm (We saw that two people share a bedroom. There are no records to show tha\ t each )Tj 1 0 0 1 34.32001 254.22 Tm (person has been consulted or made an informed choice about this, as shou\ ld happen. )Tj 1 0 0 1 34.32001 236.72 Tm (We saw that the room can be divided by a curtain. When we asked one pers\ on if this )Tj 1 0 0 1 34.32001 219.23 Tm (was used, they told us that it isn't always. Although this person says t\ hey don't mind, )Tj 1 0 0 1 34.32001 201.73 Tm (it is unclear what the other person sharing this room thinks or feels ab\ out this as they )Tj 1 0 0 1 34.32001 184.23 Tm (have communication difficulties.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (One health care professional commented that sometimes shared rooms creat\ e )Tj 1 0 0 1 34.32001 131.75 Tm (problems around privacy and dignity. )Tj ET endstream endobj 641 0 obj 5858 endobj 642 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 437.25 m 562.53998 437.25 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 119.35001 w 33.47 426 m 563.65997 426 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87994 m 32.35001 364.12 l S 564.78998 487.87994 m 564.78998 364.12 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 365.20001 m 565.87 365.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Some people's quality of life is enhanced by continued links with their \ families and )Tj 1 0 0 1 36.62 409.25 Tm (friends and by the activities they take part in. However, not everyone i\ s having their )Tj 1 0 0 1 36.62 391.75998 Tm (individual social needs and rights to make choices met.)Tj 1 0 0 1 36.62 374.25998 Tm (People enjoy an appetising, balanced diet that meets their nutritional n\ eeds.)Tj 1 0 0 1 28.35001 349.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 257.30002 w 34.60001 210.67998 m 562.53998 210.67998 l S 1 1 1 RG 22.5 w 32.35001 330.32999 m 564.78998 330.32999 l S 235.92998 w 33.47 198.87 m 563.65997 198.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 317.95999 m 565.87 317.95999 l S 32.35001 319.03998 m 32.35001 78.70001 l S 564.78998 319.03998 m 564.78998 78.70001 l S 32.35001 317.95999 m 564.78998 317.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 327.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 302.26999 Tm (Since the last inspection the home has employed an activities co-ordinat\ or for 20 )Tj 1 0 0 1 36.57001 284.78 Tm (hours each week. This person is responsible for meeting the social needs\ of all the )Tj 1 0 0 1 36.57001 267.28 Tm (people living here and provides support with helping people to eat and w\ ith personal )Tj 1 0 0 1 36.57001 249.78998 Tm (care such as cutting people's nails.)Tj 1 0 0 1 36.57001 232.28998 Tm (\240)Tj 1 0 0 1 36.57001 214.78998 Tm (In surveys people told us there are usually activities they can take par\ t in if they want )Tj 1 0 0 1 36.57001 197.3 Tm (to. We saw that about 4 people who spend their time in the lounge are we\ ll attended )Tj 1 0 0 1 36.57001 179.8 Tm (to. We saw people took part in a picture quiz, in card games and in phys\ ical activity. )Tj 1 0 0 1 36.57001 162.31 Tm (These people were having fun, were being included, were relaxed and were\ treated )Tj 1 0 0 1 36.57001 144.81 Tm (with respect and with warmth. We saw that one person in particular is re\ ally )Tj 1 0 0 1 36.57001 127.31 Tm (benefiting from having this social interaction.)Tj 1 0 0 1 36.57001 109.82001 Tm (\240)Tj 1 0 0 1 36.57001 92.32001 Tm (We also saw the the lounge is laid out in such a way that separate areas\ have been )Tj ET endstream endobj 643 0 obj 4934 endobj 644 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (created. This means that people can take part in different activities or\ have )Tj 1 0 0 1 34.32001 761.60004 Tm (conversations without disturbing anyone else, and away from the televisi\ on. The )Tj 1 0 0 1 34.32001 744.10999 Tm (television was on throughout the day during this inspection. It was set \ to a very high )Tj 1 0 0 1 34.32001 726.60999 Tm (volume and no one was watching it. One person did take an interest when \ the )Tj 1 0 0 1 34.32001 709.10999 Tm (lunchtime news came on. They told us they like to hear the news, but tha\ t they're not )Tj 1 0 0 1 34.32001 691.62 Tm (bothered otherwise.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We saw one person enjoying knitting who also benefited from the activiti\ es organised. )Tj 1 0 0 1 34.32001 639.13 Tm (Other people were invited to join in and declined or were unable to do s\ o due to their )Tj 1 0 0 1 34.32001 621.63 Tm (disabilities.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (Other people living in this home spend time in their rooms. We spoke wit\ h staff about )Tj 1 0 0 1 34.32001 569.14996 Tm (how these people are supported to have their social needs met. We were t\ old the )Tj 1 0 0 1 34.32001 551.64996 Tm (activities co-ordinator spends time with these people in their rooms. We\ found that, )Tj 1 0 0 1 34.32001 534.14996 Tm (whilst well intentioned and very skillful, this person cannot meet the s\ ocial needs of all )Tj 1 0 0 1 34.32001 516.65997 Tm (the people living here. People who are physically or mentally disabled s\ pend long )Tj 1 0 0 1 34.32001 499.16 Tm (periods alone.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (One person told us they get bored lying in bed all day. Their relative s\ aid that staff )Tj 1 0 0 1 34.32001 446.66998 Tm (come into the room, but that this is to carry out care tasks such as tur\ ning. The care )Tj 1 0 0 1 34.32001 429.17999 Tm (plan for this person does not contain any information about their intere\ sts or religious )Tj 1 0 0 1 34.32001 411.67999 Tm (or spiritual needs.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Other care plans contain some information about people's interests. Howe\ ver, )Tj 1 0 0 1 34.32001 359.19 Tm (knowledge about these interests is not being used to meet each person's \ need to be )Tj 1 0 0 1 34.32001 341.70001 Tm (engaged and be social in an individualised way.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (For example each care plan has sections about people's spiritual needs. \ The care plan )Tj 1 0 0 1 34.32001 289.20999 Tm (of one person who has dementia states they are very religious and identi\ fies their )Tj 1 0 0 1 34.32001 271.70999 Tm (religion. The care plan section relating to social needs records that th\ is person loves to )Tj 1 0 0 1 34.32001 254.22 Tm (go out. The care plan does not identify how this person will be supporte\ d to attend a )Tj 1 0 0 1 34.32001 236.72 Tm (religious service or how they will be helped to go out. Staff tell us th\ is person does not )Tj 1 0 0 1 34.32001 219.23 Tm (go to church and does not go out. In addition, the part of the care plan\ relating to )Tj 1 0 0 1 34.32001 201.73 Tm (people's death and dying needs states that this person should be encoura\ ged to )Tj 1 0 0 1 34.32001 184.23 Tm (express their wishes regarding death as it approaches. This statement is\ used in all )Tj 1 0 0 1 34.32001 166.73999 Tm (the care plans we looked at where the section on death and dying had bee\ n )Tj 1 0 0 1 34.32001 149.23999 Tm (completed. This person's plan makes no mention of the arrangements this \ person )Tj 1 0 0 1 34.32001 131.75 Tm (might like in relation to their religion.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (Another person's care plan does not identify their social interests and \ we saw that this )Tj ET endstream endobj 645 0 obj 5000 endobj 646 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (person spent the day at the home in the lounge without being engaged in \ any activity.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We asked staff how decisions are made about who gets up early or late. S\ taff told us )Tj 1 0 0 1 34.32001 726.60999 Tm ('the diabetics are always got up first and that after that it depends on\ where the )Tj 1 0 0 1 34.32001 709.10999 Tm (member of staff decides to start work'. This indicates that people are n\ ot offered )Tj 1 0 0 1 34.32001 691.62 Tm (choice.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We found that the care plan for one person contains a recently written s\ tatement that )Tj 1 0 0 1 34.32001 639.13 Tm (they like to get up at 6am. It also states that the nurse writing this h\ as discussed this )Tj 1 0 0 1 34.32001 621.63 Tm (with the person and that they agree with this. This person is described \ in the care plan )Tj 1 0 0 1 34.32001 604.14001 Tm (as having dementia and being confused. We found this statement in the ca\ re plan of )Tj 1 0 0 1 34.32001 586.64001 Tm (another person who is also described as having dementia. This means that\ people who )Tj 1 0 0 1 34.32001 569.14996 Tm (cannot speak up for themselves do not make decisions and do not have con\ trol over )Tj 1 0 0 1 34.32001 551.64996 Tm (their individual daily lives.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj 1 0 0 1 34.32001 516.65997 Tm (Visitors told us they can visit when they like. And we saw visitors in t\ he home at )Tj 1 0 0 1 34.32001 499.16 Tm (different times of the day and evening. Some people say that staff keep \ them up to )Tj 1 0 0 1 34.32001 481.66998 Tm (date with changes and developments and others say that staff don't do th\ is.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (In surveys people told us they always like the food served in the home. \ People we )Tj 1 0 0 1 34.32001 429.17999 Tm (spoke with say they like the variety and the quality of food served. We \ heard staff )Tj 1 0 0 1 34.32001 411.67999 Tm (asking people what they would like for lunch, close to the time this was\ being served. )Tj 1 0 0 1 34.32001 394.19 Tm (This means that people are helped to make a choice about what to eat at \ a time when )Tj 1 0 0 1 34.32001 376.69 Tm (they are ready to make this decision and when it means something to them\ . We were )Tj 1 0 0 1 34.32001 359.19 Tm (unsure how staff helped people who cannot speak for themselves to make d\ ecisions )Tj 1 0 0 1 34.32001 341.70001 Tm (about what to eat. We asked a member of care staff who told us that they\ get to know )Tj 1 0 0 1 34.32001 324.20001 Tm (what people like. We saw in care plans that there are records about some\ people's )Tj 1 0 0 1 34.32001 306.70999 Tm (likes and dislikes, but not for all people. We saw records relating to w\ hat one person )Tj 1 0 0 1 34.32001 289.20999 Tm (eats. We saw that they have porridge for breakfast every day as far back\ as we saw )Tj 1 0 0 1 34.32001 271.70999 Tm (records for \(approximately 11 weeks\). They had also had scrambled egg \ for supper for )Tj 1 0 0 1 34.32001 254.22 Tm (the majority of those 11 weeks. Staff told us that this person sometimes\ does not eat )Tj 1 0 0 1 34.32001 236.72 Tm (much at supper and on the day of this inspection staff told us this pers\ on only ate 2 )Tj 1 0 0 1 34.32001 219.23 Tm (small spoonfuls of supper. The records and conversations with staff do n\ ot indicate )Tj 1 0 0 1 34.32001 201.73 Tm (that staff had explored the possibility that this person might be bored \ with their )Tj 1 0 0 1 34.32001 184.23 Tm (supper diet.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We heard that one person who spends all their time in their bedroom had \ not had )Tj 1 0 0 1 34.32001 131.75 Tm (breakfast on two occasions and that their morning tea had been missed a \ couple of )Tj 1 0 0 1 34.32001 114.25 Tm (times.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 647 0 obj 1224 endobj 648 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We also saw two people being supported to eat by staff whilst in their b\ edrooms. The )Tj 1 0 0 1 34.32001 761.60004 Tm (support given was unhurried, relaxed and sensitive. )Tj ET endstream endobj 649 0 obj 5679 endobj 650 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 505.73999 m 562.53998 505.73999 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 84.36 w 33.47 494.5 m 563.65997 494.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 450.12 l S 564.78998 538.88 m 564.78998 450.12 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 451.19 m 565.87 451.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People concerns are not always acted upon and people are not fully safeg\ uarded from )Tj 1 0 0 1 36.62 460.25 Tm (harm. )Tj 1 0 0 1 28.35001 435.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 343.30002 w 34.60001 253.67 m 562.53998 253.67 l S 1 1 1 RG 22.5 w 32.35001 416.31998 m 564.78998 416.31998 l S 321.92999 w 33.47 241.86 m 563.65997 241.86 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 403.94998 m 565.87 403.94998 l S 32.35001 405.03 m 32.35001 78.70001 l S 564.78998 405.03 m 564.78998 78.70001 l S 32.35001 403.94998 m 564.78998 403.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 413.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 388.26999 Tm (In surveys all 3 people told us that they know how to make a formal comp\ laint and 2 )Tj 1 0 0 1 36.57001 370.76999 Tm (told us there is someone they can speak with informally if they are not \ happy. One )Tj 1 0 0 1 36.57001 353.26999 Tm (person said they can only do this with their visitors.)Tj 1 0 0 1 36.57001 335.78 Tm (\240)Tj 1 0 0 1 36.57001 318.28 Tm (The information given to us in the AQAA tells us that this home has rece\ ived one )Tj 1 0 0 1 36.57001 300.78998 Tm (complaint since the last inspection a year ago. This was dealt with by t\ he home within )Tj 1 0 0 1 36.57001 283.29001 Tm (28 days, which is the timescale set, and it was upheld. It also tells us\ that one )Tj 1 0 0 1 36.57001 265.79001 Tm (safeguarding alert was made alleging that someone living at the home was\ not )Tj 1 0 0 1 36.57001 248.3 Tm (receiving care that was safe. This was investigated by the safeguarding \ team in May )Tj 1 0 0 1 36.57001 230.8 Tm (2009. The outcome of this was that the care provided was not neglectful \ or abusive, )Tj 1 0 0 1 36.57001 213.31 Tm (but was poor practice.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Since then the commission has received two complaints about the quality \ of care, )Tj 1 0 0 1 36.57001 160.81999 Tm (about staff not being available when needed, about the management of med\ icines and )Tj 1 0 0 1 36.57001 143.31999 Tm (about the general management of the home. One person said they had bough\ t their )Tj 1 0 0 1 36.57001 125.83 Tm (concerns to the attention of staff but did not get a satisfactory respon\ se. Another )Tj 1 0 0 1 36.57001 108.33 Tm (person said they thought that staff were not taking their concerns serio\ usly enough.)Tj 1 0 0 1 36.57001 90.83 Tm (\240)Tj ET endstream endobj 651 0 obj 5335 endobj 652 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We have looked at some of these issues during this inspection and are wo\ rking with )Tj 1 0 0 1 34.32001 761.60004 Tm (the safeguarding team who are undertaking an investigation relating to t\ hese )Tj 1 0 0 1 34.32001 744.10999 Tm (allegations. In addition Devon County Council are reviewing the care of \ the people )Tj 1 0 0 1 34.32001 726.60999 Tm (living here.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (The AQAA tells us that no one living here is subject to any form of rest\ raint. However, )Tj 1 0 0 1 34.32001 674.12 Tm (a referral was made under the Deprivation of Liberty and Mental Capacity\ Act because )Tj 1 0 0 1 34.32001 656.63 Tm (one person is being restrained in their wheelchair. This is not a depriv\ ation of liberty )Tj 1 0 0 1 34.32001 639.13 Tm (but is a form of restraint. We saw that this continues. We also saw in a\ care plan that )Tj 1 0 0 1 34.32001 621.63 Tm (another person is restrained in their chair by using a lap belt when the\ y try to stand )Tj 1 0 0 1 34.32001 604.14001 Tm (up. We saw that people have bed rails whilst in their beds, which is ano\ ther form of )Tj 1 0 0 1 34.32001 586.64001 Tm (restraint. There is some indication that the restraint used for people w\ hilst sitting in )Tj 1 0 0 1 34.32001 569.14996 Tm (their chairs might not always be appropriate. This is because records st\ ate that it is )Tj 1 0 0 1 34.32001 551.64996 Tm (used when people try to stand up or get agitated. The use of restraint i\ s sometimes )Tj 1 0 0 1 34.32001 534.14996 Tm (the only action that can be taken to keep someone safe. However, records\ should )Tj 1 0 0 1 34.32001 516.65997 Tm (show that all other actions to reduce risk have been tried before this a\ ction is taken. )Tj 1 0 0 1 34.32001 499.16 Tm (In addition, care plans do not give clear and specific instructions as t\ o when restraint )Tj 1 0 0 1 34.32001 481.66998 Tm (should be used and for how long. We asked staff about the use of restrai\ nt in the form )Tj 1 0 0 1 34.32001 464.16998 Tm (of a lap belt for one person. They told us that they use it only when ne\ eded, when )Tj 1 0 0 1 34.32001 446.66998 Tm (staff are not around, and for a few hours. This means that restraint is \ being used for )Tj 1 0 0 1 34.32001 429.17999 Tm (long periods when staff are not around to supervise vulnerable and agita\ ted people.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (People who live here are having decisions about forms of restraint made \ by staff or )Tj 1 0 0 1 34.32001 376.69 Tm (relatives. Sometimes this has to happen if the person involved is not ab\ le to make )Tj 1 0 0 1 34.32001 359.19 Tm (these decisions for themselves. The circumstances of these decisions sho\ uld be )Tj 1 0 0 1 34.32001 341.70001 Tm (recorded so that it is clear that these decisions are being made in the \ best interests of )Tj 1 0 0 1 34.32001 324.20001 Tm (that person. Such records are not being kept for people living in this h\ ome.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We saw three people who have bruises or broken skin. We asked staff abou\ t these. )Tj 1 0 0 1 34.32001 271.70999 Tm (They gave us explanations for two but staff did not know what had caused\ the third )Tj 1 0 0 1 34.32001 254.22 Tm (injury. We saw in care records that one person's injury had been caused \ when they )Tj 1 0 0 1 34.32001 236.72 Tm (had resisted care. The circumstances of this have not been investigated \ and actions )Tj 1 0 0 1 34.32001 219.23 Tm (have not been taken to prevent this happening again. Another person inju\ red them )Tj 1 0 0 1 34.32001 201.73 Tm (self on a bed rail and there are no records to show that actions have be\ en taken to )Tj 1 0 0 1 34.32001 184.23 Tm (prevent this happening again.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We spoke with staff about what they would do if they saw or suspected ab\ use. They )Tj 1 0 0 1 34.32001 131.75 Tm (told us they would tell the nurse in charge, as is good practice. We ask\ ed the nurse in )Tj 1 0 0 1 34.32001 114.25 Tm (charge what they would do, and the actions they describe are contrary to\ the guidance )Tj 1 0 0 1 34.32001 96.75 Tm (given in the multi-agency guidance. This person told us that they had re\ ceived )Tj ET endstream endobj 653 0 obj 1252 endobj 654 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (training and had a copy of the guidance in the home. However, the guidan\ ce they )Tj 1 0 0 1 34.32001 761.60004 Tm (showed us would not guide them to take appropriate action if abuse were \ suspected. )Tj ET endstream endobj 655 0 obj 5720 endobj 656 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 488.73999 m 562.53998 488.73999 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 84.36 w 33.47 477.5 m 563.65997 477.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 433.12 l S 564.78998 521.88 m 564.78998 433.12 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 434.19 m 565.87 434.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (People living here enjoy a homely environment. However, improvements are\ needed )Tj 1 0 0 1 36.62 443.25 Tm (to ensure that people are fully protected from infection. )Tj 1 0 0 1 28.35001 418.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 326.30002 w 34.60001 245.17 m 562.53998 245.17 l S 1 1 1 RG 22.5 w 32.35001 399.31998 m 564.78998 399.31998 l S 304.92999 w 33.47 233.36 m 563.65997 233.36 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 386.94998 m 565.87 386.94998 l S 32.35001 388.03 m 32.35001 78.70001 l S 564.78998 388.03 m 564.78998 78.70001 l S 32.35001 386.94998 m 564.78998 386.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 396.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 371.26999 Tm (In surveys people told us that the home is usually clean and fresh. On t\ he day we )Tj 1 0 0 1 36.57001 353.76999 Tm (visited we found it to be clean and odour free.)Tj 1 0 0 1 36.57001 336.26999 Tm (\240)Tj 1 0 0 1 36.57001 318.78 Tm (The home is warm, and is furnished and decorated in a domestic and homel\ y style. )Tj 1 0 0 1 36.57001 301.28 Tm (There is a reception area in the large hall, where there is usually a me\ mber of staff )Tj 1 0 0 1 36.57001 283.79001 Tm (during the day so that people visiting the home can speak with them. The\ re is also a )Tj 1 0 0 1 36.57001 266.29001 Tm (large board in the hall displaying the photographs and names of the staf\ f working at )Tj 1 0 0 1 36.57001 248.78998 Tm (the home. This is helpful so that people can identify and become familia\ r with staff.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The home has one large lounge and a dining room. Both are decorated and \ furnished )Tj 1 0 0 1 36.57001 196.31 Tm (in a homely style. The tables in the dining room are smaller and this he\ lps people to )Tj 1 0 0 1 36.57001 178.81 Tm (sit in smaller groups and to experience meals as a social occasion. The \ lounge is )Tj 1 0 0 1 36.57001 161.31 Tm (divided into smaller seating areas so that people can carry out differen\ t activities )Tj 1 0 0 1 36.57001 143.81999 Tm (without disturbing others. This area is very bright as it has large wind\ ows to the side )Tj 1 0 0 1 36.57001 126.32001 Tm (and rear of the house.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (We saw staff washing their hands and wearing protective clothing as a wa\ y of helping )Tj ET endstream endobj 657 0 obj 2517 endobj 658 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (to prevent the spread of infection. Staff use alcohol gel as another way\ of preventing )Tj 1 0 0 1 34.32001 761.60004 Tm (the spread of infection, and this is also available for visitors to the \ home to use.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we saw that the sluice did not have liquid soap for staff to wa\ sh their hands, )Tj 1 0 0 1 34.32001 709.10999 Tm (and that some soap dispensers appear dirty and one was empty.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last inspection by the commission the home have also been visi\ ted by the )Tj 1 0 0 1 34.32001 656.63 Tm (fire authority. Some actions were required and these have been carried o\ ut. We saw )Tj 1 0 0 1 34.32001 639.13 Tm (that access from the home is controlled at the front door by a key pad s\ ystem and )Tj 1 0 0 1 34.32001 621.63 Tm (were told that this is linked to the fire alarm. This means that when th\ e fire alarm )Tj 1 0 0 1 34.32001 604.14001 Tm (sounds that the door lock will automatically be opened, and is good prac\ tice.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We were told that some areas of the home have been redecorated. We saw o\ ne )Tj 1 0 0 1 34.32001 551.64996 Tm (upstairs window being replaced. We saw that staff test and record the te\ mperature of )Tj 1 0 0 1 34.32001 534.14996 Tm (bathing water as is good practice to ensure that accidental scalding is \ prevented. )Tj ET endstream endobj 659 0 obj 5784 endobj 660 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 480 m 562.53998 480 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 101.85001 w 33.47 468.75 m 563.65997 468.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 415.62 l S 564.78998 521.88 m 564.78998 415.62 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 416.70001 m 565.87 416.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (There are not always enough staff on duty with the appropriate qualifica\ tions, training )Tj 1 0 0 1 36.62 443.25 Tm (and skills to care for people living here. Practices in relation to recr\ uitment are placing )Tj 1 0 0 1 36.62 425.75998 Tm (people at risk of harm. )Tj 1 0 0 1 28.35001 401.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 308.80002 w 34.60001 236.42998 m 562.53998 236.42998 l S 1 1 1 RG 22.5 w 32.35001 381.82999 m 564.78998 381.82999 l S 287.42999 w 33.47 224.62 m 563.65997 224.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 369.44998 m 565.87 369.44998 l S 32.35001 370.53 m 32.35001 78.70001 l S 564.78998 370.53 m 564.78998 78.70001 l S 32.35001 369.44998 m 564.78998 369.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 378.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 353.76999 Tm (This is a nursing home and should have a registered nurse on duty throug\ hout the day )Tj 1 0 0 1 36.57001 336.26999 Tm (and night. We were contacted by a person who was concerned this was not \ )Tj 1 0 0 1 36.57001 318.78 Tm (happening. We contacted the home and it was confirmed that on one night \ there was )Tj 1 0 0 1 36.57001 301.28 Tm (not a nurse on duty. We asked the owner why they had not used an agency \ nurse to )Tj 1 0 0 1 36.57001 283.79001 Tm (cover this shift. They told us that this home never uses agency staff. T\ hey told us that )Tj 1 0 0 1 36.57001 266.29001 Tm (due to staff sickness they had arranged for a nurse to sleep at the home\ on that night. )Tj 1 0 0 1 36.57001 248.78998 Tm (This practice puts people at risk.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The caller was also concerned that there are not enough staff on duty. W\ e spoke to )Tj 1 0 0 1 36.57001 196.31 Tm (the owner about this. She told us that staffing has been reduced but tha\ t there are )Tj 1 0 0 1 36.57001 178.81 Tm (enough staff on duty to meet people's current needs. We looked at the du\ ty rota and )Tj 1 0 0 1 36.57001 161.31 Tm (saw that there had previously been 3 or 4 carers on duty in the morning \ and this had )Tj 1 0 0 1 36.57001 143.81999 Tm (been reduced to 2 or 3 carers. In the afternoon we saw that there used t\ o be 2 or 3 )Tj 1 0 0 1 36.57001 126.32001 Tm (carers on duty in the afternoon, and now there are 2. On the day of this\ inspection )Tj 1 0 0 1 36.57001 108.83 Tm (there was a nurse on duty with 3 carers, an administrator, cook and the \ temporary )Tj 1 0 0 1 36.57001 91.33 Tm (manager.)Tj ET endstream endobj 661 0 obj 4923 endobj 662 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We saw in the information given to us by the home prior to the inspectio\ n that there )Tj 1 0 0 1 34.32001 744.10999 Tm (are 14 people living at the home who need help with undressing and dress\ ing, and )Tj 1 0 0 1 34.32001 726.60999 Tm (need help to go to the toilet. 11 people are incontinent of both faeces \ and urine and 8 )Tj 1 0 0 1 34.32001 709.10999 Tm (people have dementia. 11 people need two members of staff to help them w\ ith their )Tj 1 0 0 1 34.32001 691.62 Tm (care.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (In surveys one person told us that staff are usually available, one that\ staff are )Tj 1 0 0 1 34.32001 639.13 Tm (sometimes available and one that staff are never available when needed. \ Comments )Tj 1 0 0 1 34.32001 621.63 Tm (included staff are not always available, and the home is very short of s\ taff. The )Tj 1 0 0 1 34.32001 604.14001 Tm (surveys also asked what the home could do better. People said employ mor\ e staff who )Tj 1 0 0 1 34.32001 586.64001 Tm (can speak and understand English and train and employ more staff especia\ lly at night. )Tj 1 0 0 1 34.32001 569.14996 Tm (Staff were however described as nice and lovely.)Tj 1 0 0 1 34.32001 551.64996 Tm (\240)Tj 1 0 0 1 34.32001 534.14996 Tm (We looked at the records relating to falls and injuries. According to th\ ese records )Tj 1 0 0 1 34.32001 516.65997 Tm (people have been found to have fallen when there have been no staff pres\ ent on 14 )Tj 1 0 0 1 34.32001 499.16 Tm (separate occasions since the beginning of July this year. This means tha\ t people are )Tj 1 0 0 1 34.32001 481.66998 Tm (not being sufficiently supervised by staff to keep them safe.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We know that these accident records are incomplete. We are aware that on\ e person )Tj 1 0 0 1 34.32001 429.17999 Tm (has fallen whilst alone, and this is not recorded. We also saw that two \ people had )Tj 1 0 0 1 34.32001 411.67999 Tm (injuries which have not been recorded as accidents or incidents.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We looked at the duty rota and found that is is not always accurate. For\ example, on )Tj 1 0 0 1 34.32001 359.19 Tm (some weeks the manager, who has left the home, is recorded as on duty. I\ n addition, )Tj 1 0 0 1 34.32001 341.70001 Tm (the temporary manager has not been included on the duty rota until Septe\ mber )Tj 1 0 0 1 34.32001 324.20001 Tm (although they say they started work at the home in August.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We asked to see the records of staff training. We were told that these a\ re incomplete )Tj 1 0 0 1 34.32001 271.70999 Tm (because the records about training have gone missing since the manager l\ eft the )Tj 1 0 0 1 34.32001 254.22 Tm (home. We saw that some records had been made about training, but that th\ ere were )Tj 1 0 0 1 34.32001 236.72 Tm (large gaps. The management team tell us that this means they are not ful\ ly aware of )Tj 1 0 0 1 34.32001 219.23 Tm (what training staff have had, and what training might be needed. We did \ see a notice )Tj 1 0 0 1 34.32001 201.73 Tm (that said that training has been arranged for staff in relation preventi\ ng people from )Tj 1 0 0 1 34.32001 184.23 Tm (falling.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (Staff told us they had had some training. One told us they had had train\ ing in how to )Tj 1 0 0 1 34.32001 131.75 Tm (provide care to people, another that they thought they had had training \ in relation to )Tj 1 0 0 1 34.32001 114.25 Tm (supporting people who have problems with swallowing. However, they went \ on to )Tj 1 0 0 1 34.32001 96.75 Tm (describe training which relates to nutritional supplements. One person t\ hought they )Tj ET endstream endobj 663 0 obj 2380 endobj 664 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 266.32001 w 34.60001 678.25 m 562.53998 678.25 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 244.93999 w 33.47 666.44 m 563.65997 666.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 541.76001 l S 564.78998 791.10999 m 564.78998 541.76001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 542.83997 m 565.87 542.83997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (had had training about dementia, and gave a description of how to care f\ or someone )Tj 1 0 0 1 34.32001 761.60004 Tm (with dementia which was an example of good practice.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we also saw that staff record that people have drunk more than \ they have. )Tj 1 0 0 1 34.32001 709.10999 Tm (We heard staff trying to persuade a confused person that their understan\ ding of a )Tj 1 0 0 1 34.32001 691.62 Tm (situation was wrong, causing distress and confusion to this person. We a\ lso saw staff )Tj 1 0 0 1 34.32001 674.12 Tm (ignoring one person who was trying to attract their attention.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (The AQAA told us that 10 of the 12 carers working at this home have achi\ eved a )Tj 1 0 0 1 34.32001 621.63 Tm (National Vocational Qualification \(NVQ\) in care, to level 2 or above. \ We asked the )Tj 1 0 0 1 34.32001 604.14001 Tm (manager if there is a system in place to ensure that staff practice the \ skills they are )Tj 1 0 0 1 34.32001 586.64001 Tm (taught, and to ensure they do this to the level of quality that is expec\ ted. The )Tj 1 0 0 1 34.32001 569.14996 Tm (manager told us that this is the nurses responsibility and that there is\ no formal )Tj 1 0 0 1 34.32001 551.64996 Tm (system.)Tj ET endstream endobj 665 0 obj 5831 endobj 666 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 395 m 562.53998 395 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 101.85001 w 33.47 383.75 m 563.65997 383.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 330.62 l S 564.78998 436.88 m 564.78998 330.62 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 331.70001 m 565.87 331.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of leadership in this home means that systems are not in place to e\ nsure that )Tj 1 0 0 1 36.62 358.25 Tm (people receive the care they need to an acceptable standard in a way tha\ t promotes )Tj 1 0 0 1 36.62 340.75998 Tm (their safety. )Tj 1 0 0 1 28.35001 316.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.8 w 34.60001 193.92999 m 562.53998 193.92999 l S 1 1 1 RG 22.5 w 32.35001 296.82999 m 564.78998 296.82999 l S 202.42998 w 33.47 182.12 m 563.65997 182.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 284.44998 m 565.87 284.44998 l S 32.35001 285.53 m 32.35001 78.70001 l S 564.78998 285.53 m 564.78998 78.70001 l S 32.35001 284.44998 m 564.78998 284.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.76999 Tm (This home does not have a Registered Manager. The previous manager left \ in August )Tj 1 0 0 1 36.57001 251.26999 Tm (2009. Since that time the home has been managed on a temporary basis. Th\ e )Tj 1 0 0 1 36.57001 233.78 Tm (temporary manager is a Registered Nurse and is studying for a Leadership\ and )Tj 1 0 0 1 36.57001 216.28 Tm (Management qualification. She had been working as the \(unregistered\) m\ anager of )Tj 1 0 0 1 36.57001 198.78998 Tm (the owners' residential home, and works from 9am - 3pm four days weekly.\ She is )Tj 1 0 0 1 36.57001 181.28998 Tm (supernumerary to nursing hours and is supported by two of the four owner\ s of this )Tj 1 0 0 1 36.57001 163.78999 Tm (home, who are also nurses.)Tj 1 0 0 1 36.57001 146.3 Tm (\240)Tj 1 0 0 1 36.57001 128.8 Tm (In the last few months the commission has received comments from relativ\ es of )Tj 1 0 0 1 36.57001 111.31 Tm (people living here who say the overall management of the home has declin\ ed. One )Tj 1 0 0 1 36.57001 93.81 Tm (person described the management as chaotic, saying that this has resulte\ d in people )Tj ET endstream endobj 667 0 obj 5070 endobj 668 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (not getting the care they need.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked to see if there are systems in place to ensure the home runs e\ fficiently and )Tj 1 0 0 1 34.32001 726.60999 Tm (safely, and that people get the care they need. We found that systems ar\ e not robust )Tj 1 0 0 1 34.32001 709.10999 Tm (enough to achieve this.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (For example we looked at the system for communicating peoples' needs and\ changing )Tj 1 0 0 1 34.32001 656.63 Tm (needs, and for ensuring that peoples' needs are met. The owners and mana\ ger told us )Tj 1 0 0 1 34.32001 639.13 Tm (that this is achieved through the care planning system. However, we foun\ d that these )Tj 1 0 0 1 34.32001 621.63 Tm (documents are complex and contradictory in places. They do not always pr\ ovide the )Tj 1 0 0 1 34.32001 604.14001 Tm (level of detail needed by staff to ensure that they have the information\ they need, and )Tj 1 0 0 1 34.32001 586.64001 Tm (to ensure that people's needs are met in a way that is consistent and of\ a satisfactory )Tj 1 0 0 1 34.32001 569.14996 Tm (quality. We found that reviews of people's care do not include all the i\ nformation )Tj 1 0 0 1 34.32001 551.64996 Tm (available and do not always provide evidence for some of the care decisi\ ons made )Tj 1 0 0 1 34.32001 534.14996 Tm (\(see Health and Personal Care\). Care staff told us they do not read ca\ re plans. We )Tj 1 0 0 1 34.32001 516.65997 Tm (asked if they got a hand over of information at the beginning of each sh\ ift and they )Tj 1 0 0 1 34.32001 499.16 Tm (told us they do not. We asked the manager how information is relayed to \ staff. She )Tj 1 0 0 1 34.32001 481.66998 Tm (told us that she expects the nurses to do this. The evidence in the Heal\ th and Personal )Tj 1 0 0 1 34.32001 464.16998 Tm (Care section of this report, shows that this is not happening.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked closely at how some decisions about people's care are made. Fo\ r example, )Tj 1 0 0 1 34.32001 411.67999 Tm (one record states that one person cannot make a decision about having be\ d rails on )Tj 1 0 0 1 34.32001 394.19 Tm (their bed. However, records show that this person has made a decision ab\ out having )Tj 1 0 0 1 34.32001 376.69 Tm (repeated invasive procedures. Another person can make the decision to ge\ t up at 6am )Tj 1 0 0 1 34.32001 359.19 Tm (but cannot make a decision about what they eat.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at how risks in the home are managed. We found that people are\ identified )Tj 1 0 0 1 34.32001 306.70999 Tm (as being at risk of falling. Care records instruct staff to observe them\ . Records show )Tj 1 0 0 1 34.32001 289.20999 Tm (that a lot of falls have happened to people when staff are not present. \ Although there )Tj 1 0 0 1 34.32001 271.70999 Tm (is a system for recording this information, there is not a system for mo\ nitoring and )Tj 1 0 0 1 34.32001 254.22 Tm (analysing this information, and therefore actions have not been taken to\ help prevent )Tj 1 0 0 1 34.32001 236.72 Tm (and reduce the number of falls.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (We looked to see if there is a safe system in place for moving and handl\ ing people )Tj 1 0 0 1 34.32001 184.23 Tm (with mobility problems. We found that assessments have not been carried \ out or had )Tj 1 0 0 1 34.32001 166.73999 Tm (been carried out a long time ago and have not been reviewed. We found th\ at decisions )Tj 1 0 0 1 34.32001 149.23999 Tm (about the type of equipment to be used are based on the equipment that i\ s available )Tj 1 0 0 1 34.32001 131.75 Tm (and not on what would be the most suitable for each person. The manager \ reports )Tj 1 0 0 1 34.32001 114.25 Tm (that staff have not had training in how to carry out moving and handling\ assessments.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 669 0 obj 5058 endobj 670 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We looked at how other risks in the home have been managed. We found tha\ t the )Tj 1 0 0 1 34.32001 761.60004 Tm (temperature of hot water is restricted to help ensure that people are no\ t scalded. We )Tj 1 0 0 1 34.32001 744.10999 Tm (found that windows have restricted openings to prevent people falling. H\ owever, we )Tj 1 0 0 1 34.32001 726.60999 Tm (found one window, that had been replaced that day, did not have a restri\ cted opening. )Tj 1 0 0 1 34.32001 709.10999 Tm (We told one of the owners who told us they thought that it had been rest\ ricted since )Tj 1 0 0 1 34.32001 691.62 Tm (we last looked. When we looked again, it had not.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked in the kitchen and found it clean and tidy. The owners identif\ ied )Tj 1 0 0 1 34.32001 639.13 Tm (approximately 4 years ago that the kitchen is coming to the end of its u\ seful life, and )Tj 1 0 0 1 34.32001 621.63 Tm (the Environmental Health Officer also identified this. The cook reports \ that a )Tj 1 0 0 1 34.32001 604.14001 Tm (refurbishment date has not yet been set.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We looked at how equipment is maintained. We found that the weighing sca\ les had )Tj 1 0 0 1 34.32001 551.64996 Tm (been weighing inaccurately for some time meaning that people at risk of \ malnutrition )Tj 1 0 0 1 34.32001 534.14996 Tm (could not be weighed accurately. The lift broke down for at least 2 days\ in October.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We looked at how the home involve people in the running of the home and \ how the )Tj 1 0 0 1 34.32001 481.66998 Tm (management team get feedback from people and improve the quality of care\ given. )Tj 1 0 0 1 34.32001 464.16998 Tm (We were told by relatives that meetings are sometimes held to which they\ are invited. )Tj 1 0 0 1 34.32001 446.66998 Tm (One person told us at that at the last meeting they had been informed th\ ere were )Tj 1 0 0 1 34.32001 429.17999 Tm (going to be a lot of changes in the home. They asked for, and the manage\ ment team )Tj 1 0 0 1 34.32001 411.67999 Tm (agreed they could have, a list of these changes so that they could prepa\ re their parent )Tj 1 0 0 1 34.32001 394.19 Tm (for these changes. They have not received this.)Tj 1 0 0 1 34.32001 376.69 Tm (\240)Tj 1 0 0 1 34.32001 359.19 Tm (We looked at the results of the most recent quality assurance survey \(J\ une 2009\). )Tj 1 0 0 1 34.32001 341.70001 Tm (Some people had said they were not satisfied with the length of time it \ took to answer )Tj 1 0 0 1 34.32001 324.20001 Tm (call bells. One person said that new staff were not given enough trainin\ g meaning that )Tj 1 0 0 1 34.32001 306.70999 Tm (they had to take instruction from the person they were meant to be carin\ g for. Two )Tj 1 0 0 1 34.32001 289.20999 Tm (people thought that improvements should be made to laundry and one to ir\ oning. We )Tj 1 0 0 1 34.32001 271.70999 Tm (asked how these issues had been addressed and the owner did not know bec\ ause the )Tj 1 0 0 1 34.32001 254.22 Tm (survey was carried out when the previous manager was employed.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We checked to see if previous requirements set by the commission have be\ en met. )Tj 1 0 0 1 34.32001 201.73 Tm (We found that requirements relating to health and welfare, care planning\ , )Tj 1 0 0 1 34.32001 184.23 Tm (safeguarding people, meeting people's social needs, staff skills and imp\ roving the )Tj 1 0 0 1 34.32001 166.73999 Tm (overall management have not been met.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We did not check any personal allowance accounts of the people living he\ re as the )Tj 1 0 0 1 34.32001 114.25 Tm (home does not hold any money on behalf of people. Instead they run a deb\ it account, )Tj 1 0 0 1 34.32001 96.75 Tm (recording all monies spent on people's behalf. Records and receipts are \ given to )Tj ET endstream endobj 671 0 obj 1648 endobj 672 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (35)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 126.35001 w 34.60001 748.22998 m 562.53998 748.22998 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 104.98 w 33.47 736.41998 m 563.65997 736.41998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 681.72998 l S 564.78998 791.10999 m 564.78998 681.72998 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 682.81 m 565.87 682.81 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (relatives and supporters for them to check and to pay for retrospectivel\ y.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (During our inspection it came to light that the commission are not being\ notified of all )Tj 1 0 0 1 34.32001 726.60999 Tm (incidents that affect the welfare of people living here as they should b\ e. 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This includes working )Tj 1 0 0 1 294.54999 507.28 Tm (towards understanding what )Tj 1 0 0 1 294.54999 492.70001 Tm (people with dementia are )Tj 1 0 0 1 294.54999 478.12 Tm (trying to communicate and )Tj 1 0 0 1 294.54999 463.53998 Tm (taking action to address what )Tj 1 0 0 1 294.54999 448.95999 Tm (is being communicated.)Tj 1 0 0 1 294.54999 431.38 Tm (\240)Tj 1 0 0 1 294.54999 416.80002 Tm (In this way each individual )Tj 1 0 0 1 294.54999 402.22 Tm (with dementia will have their )Tj 1 0 0 1 294.54999 387.63998 Tm (mental health and welfare )Tj 1 0 0 1 294.54999 373.06 Tm (needs understood and met. )Tj 1 0 0 1 478.89996 565.60004 Tm (20/02/2009)Tj 1 0 0 1 35.5 353.22998 Tm (5)Tj 1 0 0 1 96.15001 350.22998 Tm (12)Tj 1 0 0 1 202.5 350.22998 Tm (16)Tj 1 0 0 1 294.54999 350.22998 Tm (\(2\) \(m\) \(n\) People must )Tj 1 0 0 1 294.54999 335.64999 Tm (have their social needs and )Tj 1 0 0 1 294.54999 321.07001 Tm (interests identified and you )Tj 1 0 0 1 294.54999 306.48999 Tm (must make 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They )Tj 1 0 0 1 294.54999 448.95999 Tm (must record their findings )Tj 1 0 0 1 294.54999 434.38 Tm (and send these to the )Tj 1 0 0 1 294.54999 419.80002 Tm (commission after each visit.)Tj 1 0 0 1 294.54999 405.22 Tm (\240)Tj 1 0 0 1 294.54999 390.63998 Tm (Previous timescale of )Tj 1 0 0 1 294.54999 376.06 Tm (13/04/07 not met.)Tj 1 0 0 1 294.54999 361.47998 Tm (\240)Tj 1 0 0 1 294.54999 346.89999 Tm (Not inspected on this )Tj 1 0 0 1 294.54999 332.32001 Tm (occasion. 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This )Tj 1 0 0 1 298.04999 446.73999 Tm (assessment must include )Tj 1 0 0 1 298.04999 429.73999 Tm (health and social care )Tj 1 0 0 1 298.04999 412.73999 Tm (assessments if the )Tj 1 0 0 1 298.04999 395.73999 Tm (placement takes place )Tj 1 0 0 1 298.04999 378.73999 Tm (through health or social care )Tj 1 0 0 1 298.04999 361.73999 Tm (services. )Tj 1 0 0 1 298.04999 344.73999 Tm (\240)Tj 1 0 0 1 298.04999 327.73999 Tm (This will help to ensure that )Tj 1 0 0 1 298.04999 310.73999 Tm (each person's needs are )Tj 1 0 0 1 298.04999 293.73999 Tm (identified and can be met. )Tj 1 0 0 1 482.10001 514.73999 Tm (07/12/2009)Tj 1 0 0 1 554.04999 514.73999 Tm (\240)Tj 1 0 0 1 35.5 274.48999 Tm (2)Tj 1 0 0 1 99.3 274.48999 Tm (7)Tj 1 0 0 1 201.55 274.48999 Tm (15)Tj 1 0 0 1 298.04999 274.48999 Tm (You must ensure that care )Tj 1 0 0 1 298.04999 257.48999 Tm (plans provide clear and up )Tj 1 0 0 1 298.04999 240.48999 Tm (to date instructions on how )Tj 1 0 0 1 298.04999 223.48999 Tm (each person's care needs )Tj 1 0 0 1 298.04999 206.48999 Tm (are to be met, recorded and )Tj 1 0 0 1 298.04999 189.48999 Tm (monitored. Information )Tj 1 0 0 1 298.04999 172.48999 Tm (recorded in care plans must )Tj 1 0 0 1 298.04999 155.48999 Tm (be relevant and appropriate. )Tj 1 0 0 1 298.04999 138.48999 Tm (All parts of the care plan )Tj 1 0 0 1 298.04999 121.49001 Tm (must be reviewed and )Tj 1 0 0 1 298.04999 104.49001 Tm (updated as appropriate. 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239.06998 Tm (4)Tj 1 0 0 1 96.15001 239.06998 Tm (30)Tj 1 0 0 1 202.5 239.06998 Tm (You must ensure that staff have had the training they need )Tj 1 0 0 1 202.5 224.48999 Tm (to care for people appropriately.)Tj ET endstream endobj 693 0 obj 1872 endobj 694 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (46)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 22.5 w 22.95 802.40997 m 560.45001 802.40997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 28.35001 799.08997 Tm (Helpline:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 28.35001 781.10999 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 28.35001 759.60004 Tm (Telephone:)Tj 0 Tr 1 0 0 1 95.88 759.60004 Tm ( 03000 616161)Tj 2 Tr 1 0 0 1 28.35001 739.60004 Tm (Email:)Tj 0 Tr 1 0 0 1 66.84 739.60004 Tm ( enquiries@cqc.org.uk)Tj 2 Tr 1 0 0 1 28.35001 719.60999 Tm (Web:)Tj 0 Tr 1 0 0 1 64.35001 719.60999 Tm (www.cqc.org.uk)Tj 1 0 0 1 28.35001 699.60999 Tm (\240)Tj 1 0 0 1 28.35001 679.60999 Tm (We want people to be able to access this information. If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 695 0 obj 4539 endobj 696 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 73.32001 w 31.2 470.10999 m 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for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 699 0 obj 5469 endobj 700 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 701 0 obj 9115 endobj 702 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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625.39001 Tm (honitonmanor@aol.com)Tj 1 0 0 1 34.05 602.56 Tm (Provider web address:)Tj 1 0 0 1 273.04999 602.56 Tm (oakdash@aol.com)Tj /T1_0 10 Tf 1 0 0 1 28.35001 583.60999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 109.98 w 32.32001 518.29999 m 564.76996 518.29999 l S 1 1 1 RG 64.32001 w 355.5 542.25 m 565.90002 542.25 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 497.54999 m 353.25 497.54999 l S 1 1 1 RG 355.5 497.54999 m 565.90002 497.54999 l S 0.95294 0.95294 0.95294 RG 31.2 474.72 m 353.25 474.72 l S 1 1 1 RG 355.5 474.72 m 565.90002 474.72 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13989 m 568.10004 486.13989 l S 28.99001 575.53998 m 568.10004 575.53998 l S 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13989 m 568.10004 486.13989 l S 28.99001 463.31 m 568.10004 463.31 l S 30.07001 576.60999 m 30.07001 462.22998 l S 354.37 576.60999 m 354.37 462.22998 l S 567.01996 576.60999 m 567.01996 462.22998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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281.29001 m 534.54999 281.29001 l S 536.79999 281.29001 m 565.90002 281.29001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 292.70001 m 568.10004 292.70001 l S 28.99001 269.87 m 568.10004 269.87 l S 30.07001 293.78 m 30.07001 268.80002 l S 316.37 293.78 m 316.37 268.80002 l S 347.66998 293.78 m 347.66998 268.80002 l S 379.01999 293.78 m 379.01999 268.80002 l S 410.31998 293.78 m 410.31998 268.80002 l S 441.66998 293.78 m 441.66998 268.80002 l S 473.01999 293.78 m 473.01999 268.80002 l S 504.31998 293.78 m 504.31998 268.80002 l S 535.66998 293.78 m 535.66998 268.80002 l S 567.01996 293.78 m 567.01996 268.80002 l S BT /T1_0 12 Tf 1 0 0 1 34.05 276.51999 Tm (Date of last inspection)Tj 1 0 0 1 328.20001 276.51999 Tm (0)Tj 1 0 0 1 359.53 276.51999 Tm (4)Tj 1 0 0 1 390.85999 276.51999 Tm (1)Tj 1 0 0 1 422.17999 276.51999 Tm (1)Tj 1 0 0 1 453.53 276.51999 Tm (2)Tj 1 0 0 1 484.85999 276.51999 Tm (0)Tj 1 0 0 1 516.17999 276.51999 Tm (0)Tj 1 0 0 1 547.52997 276.51999 Tm (8)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 258 m 565.90002 258 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 248.37 m 568.10004 248.37 l S 30.07001 249.45 m 30.07001 39.14999 l S 567.01996 249.45 m 567.01996 39.14999 l S 28.99001 267.62 m 568.10004 267.62 l S 28.99001 248.37 m 568.10004 248.37 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 268.70001 m 30.07001 247.28998 l S 567.01996 268.70001 m 567.01996 247.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 254.43999 Tm (Brief description of the )Tj 1 0 0 1 177.31 254.43999 Tm (care home)Tj 1 0 0 1 35.5 235.18999 Tm (Honiton Manor is registered to provide 24 hour nursing care for up to 22\ service users )Tj 1 0 0 1 35.5 218.19 Tm (who have needs relating to 'older people'.)Tj 1 0 0 1 35.5 201.19 Tm (\240)Tj 1 0 0 1 35.5 184.19 Tm (The two-storey home is an older style building situated on the main road\ into, and )Tj 1 0 0 1 35.5 167.19 Tm (quite close to, Honiton and the local amenities. It is on public transpo\ rt routes.)Tj 1 0 0 1 35.5 150.19 Tm (\240)Tj 1 0 0 1 35.5 133.19 Tm (There are eleven single bedrooms and five double bedrooms situated on th\ e ground )Tj 1 0 0 1 35.5 116.19 Tm (and first floors. One of the double bedrooms has an ensuite bathroom. A \ passenger lift )Tj 1 0 0 1 35.5 99.19 Tm (and a staircase link the floors.)Tj 1 0 0 1 35.5 82.19 Tm (\240)Tj 1 0 0 1 35.5 65.19 Tm (Communal space is made up of a large lounge and a dining room, both on t\ he ground )Tj 1 0 0 1 35.5 48.19 Tm (floor.)Tj ET endstream endobj 703 0 obj 1404 endobj 704 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 689.07996 l S 567.01996 795.47998 m 567.01996 689.07996 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 690.14996 m 568.10004 690.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (\240)Tj 1 0 0 1 33.25 766.46997 Tm (Outside there is access to a seating area and parking.)Tj 1 0 0 1 33.25 749.46997 Tm (\240)Tj 1 0 0 1 33.25 732.46997 Tm (Current charges are \243515.00 - \243675.00 per week. Charges do not inc\ lude items such )Tj 1 0 0 1 33.25 715.46997 Tm (as newspapers, toiletries, taxis etc.)Tj 1 0 0 1 33.25 698.46997 Tm (\240)Tj ET endstream endobj 705 0 obj 3597 endobj 706 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (This unannounced key inspection was due to be undertaken in November 200\ 9. It was )Tj 1 0 0 1 35.17 240.90001 Tm (bought forward as we had received some concerns about the quality of car\ e that )Tj 1 0 0 1 35.17 226.31998 Tm (people living here are receiving.)Tj 1 0 0 1 35.17 211.73999 Tm (\240)Tj 1 0 0 1 35.17 197.14998 Tm (During this visit we \(the commission\) spoke with or observed the major\ ity of people )Tj 1 0 0 1 35.17 182.56999 Tm (living here. We could not speak with some people because they have commu\ nication )Tj 1 0 0 1 35.17 167.98999 Tm (difficulties such as dementia. We looked closely at the care, services a\ nd )Tj 1 0 0 1 35.17 153.41 Tm (accommodation offered to four people living here. This is called case tr\ acking and helps )Tj 1 0 0 1 35.17 138.84 Tm (us to make a judgment about the standard of care overall, and helps us t\ o understand )Tj 1 0 0 1 35.17 124.25 Tm (the experiences of people who live here.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (We looked at the care and attention given by staff to these people and w\ e looked at )Tj 1 0 0 1 35.17 80.50999 Tm (their assessments and at their care planning records. We looked at the e\ nvironment in )Tj 1 0 0 1 35.17 65.93001 Tm (relation to their needs and how their health and personal care needs are\ met. We also )Tj ET endstream endobj 707 0 obj 2315 endobj 708 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 280.01999 w 32.32001 672.51996 m 566.71997 672.51996 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 531.38 m 568.91998 531.38 l S 31.2 814.72998 m 31.2 530.31 l S 567.84998 814.72998 m 567.84998 530.31 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (spoke with visitors to the home, with staff and with the manager and one\ of the )Tj 1 0 0 1 32.92 788.13995 Tm (owners. We visited the majority of bedrooms and saw all service and comm\ unal areas )Tj 1 0 0 1 32.92 773.56 Tm (of the home.)Tj 1 0 0 1 32.92 758.97998 Tm (\240)Tj 1 0 0 1 32.92 744.40002 Tm (We looked at records relating to accidents and incidents, staff training\ , staff )Tj 1 0 0 1 32.92 729.82001 Tm (recruitment, medication and at some policies.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (Prior to the inspection the owners sent us their Annual Quality Assuranc\ e Assessment )Tj 1 0 0 1 32.92 686.07996 Tm (\(AQAA\) which gave us information about the home and it's management an\ d about the )Tj 1 0 0 1 32.92 671.5 Tm (needs of people living here. This document asks for evidence in relation\ to what the )Tj 1 0 0 1 32.92 656.91998 Tm (home does well and what they think they can improve upon.)Tj 1 0 0 1 32.92 642.33997 Tm (\240)Tj 1 0 0 1 32.92 627.76001 Tm (In addition, we sent surveys to 8 people living here and 3 were returned\ . We sent 8 )Tj 1 0 0 1 32.92 613.17999 Tm (surveys to staff and 3 were returned. We sent 4 surveys to health and so\ cial care )Tj 1 0 0 1 32.92 598.60004 Tm (professionals and all were returned. Feedback and comments are included \ in the )Tj 1 0 0 1 32.92 584.01996 Tm (report.)Tj 1 0 0 1 32.92 569.44 Tm (\240)Tj 1 0 0 1 32.92 554.85999 Tm (During this inspection evidence was taken under the Police and Criminal \ Evidence Act )Tj 1 0 0 1 32.92 540.27997 Tm (and this has been considered under our enforcement procedures.)Tj ET endstream endobj 709 0 obj 6453 endobj 710 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 64.32001 w 32.32001 741.65997 m 566.71997 741.65997 l S 20.58 w 32.7 696.95996 m 569.34998 696.95996 l S 93.48 w 33.82001 637.67999 m 568.21997 637.67999 l S 20.58 w 33.45 578.40002 m 570.10004 578.40002 l S 501.84 w 34.57001 314.94998 m 568.96997 314.94998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 708.38 m 568.91998 708.38 l S 31.2 776.02997 m 31.2 707.29999 l S 31.2 708.38 m 569.34998 708.38 l S 32.7 685.54999 m 569.34998 685.54999 l S 31.62 685.54999 m 570.41998 685.54999 l S 31.62 589.82001 m 570.41998 589.82001 l S 33.45 566.98999 m 570.10004 566.98999 l S 33.45 589.82001 m 570.10004 589.82001 l S 32.37 566.98999 m 571.16998 566.98999 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 686.63 m 32.7 588.73999 l S 33.45 568.07001 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 707.29999 l S 569.34998 686.63 m 569.34998 588.73999 l S 570.10004 568.07001 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (This home is warm, clean and comfortable. Staff are described as nice an\ d caring and )Tj 1 0 0 1 35.17 744.17999 Tm (as doing their best. The home has a lot of nursing equipment such as adj\ ustable beds )Tj 1 0 0 1 35.17 729.60004 Tm (and pressure relieving mattresses. People really enjoy the food served h\ ere which is )Tj 1 0 0 1 35.17 715.01996 Tm (nutritious and offers variety. )Tj /T1_0 10 Tf 1 0 0 1 568.96997 740.10999 Tm (\240)Tj 1 0 0 1 31.2 694.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 692.19 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 695.40997 Tm (\240)Tj 1 0 0 1 31.2 636.13 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 669.35999 Tm (Since the last inspection the programme of redecoration has continued. W\ e saw that a )Tj 1 0 0 1 36.67 654.77997 Tm (window was being replaced and that the front door is now secured with a \ key pad type )Tj 1 0 0 1 36.67 640.20001 Tm (lock.)Tj 1 0 0 1 36.67 625.62 Tm (The home has employed a part time activities co-ordinator and this perso\ n's efforts are )Tj 1 0 0 1 36.67 611.03998 Tm (having an impact for some people.)Tj 1 0 0 1 36.67 596.45996 Tm (The Requirement made at the last inspection in relation to medicines has\ been met. )Tj /T1_0 10 Tf 1 0 0 1 570.46997 636.13 Tm (\240)Tj 1 0 0 1 31.2 576.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 573.63 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 313.38998 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 550.79999 Tm (This home does not have a registered manager and is not being sufficient\ ly well )Tj 1 0 0 1 37.42 536.21997 Tm (managed. This has resulted in people's health and welfare needs not alwa\ ys being )Tj 1 0 0 1 37.42 521.64001 Tm (assessed or met. The care planning and communicating systems in place ar\ e not )Tj 1 0 0 1 37.42 507.06 Tm (sufficiently robust to ensure that care staff have the information they \ need about )Tj 1 0 0 1 37.42 492.47998 Tm (people's care needs and how these should be met.)Tj 1 0 0 1 37.42 477.89993 Tm (\240)Tj 1 0 0 1 37.42 463.31998 Tm (Staff are well intentioned but are not always on duty in sufficient numb\ ers, and do not )Tj 1 0 0 1 37.42 448.73999 Tm (always have the support they need, to meet people's needs. On one night \ there was )Tj 1 0 0 1 37.42 434.16 Tm (not a waking Registered Nurse on duty. Staff are not recruited in a robu\ st way and this )Tj 1 0 0 1 37.42 419.57999 Tm (means that people are at risk of being cared for by inappropriate staff.\ )Tj 1 0 0 1 37.42 405 Tm (\240)Tj 1 0 0 1 37.42 390.41998 Tm (People are not always treated with dignity and their rights to make choi\ ces or to be )Tj 1 0 0 1 37.42 375.84 Tm (engaged and sociable are not always supported. Some people's sense of se\ lf and )Tj 1 0 0 1 37.42 361.25998 Tm (personal identity is in danger of being eroded by a system that is not a\ lways person )Tj 1 0 0 1 37.42 346.67999 Tm (centred and is sometimes institutionalised.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Complaints have been made to the commission by some people. They complai\ n that )Tj 1 0 0 1 37.42 302.94 Tm (the home is not well managed and the quality of care has declined. These\ concerns are )Tj 1 0 0 1 37.42 288.35999 Tm (being investigated by the local safeguarding team. This is the second sa\ feguarding )Tj 1 0 0 1 37.42 273.78 Tm (alert that has been made since the last inspection. Whilst this investig\ ation is ongoing, )Tj 1 0 0 1 37.42 259.20001 Tm (admissions to this home via health or social care services have been sus\ pended by )Tj 1 0 0 1 37.42 244.62 Tm (Adult and Community Services.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Staff training is not up to date and some specialist training is being d\ esignated to )Tj 1 0 0 1 37.42 200.87999 Tm (people who are not qualified or experienced to carry this out.)Tj 1 0 0 1 37.42 186.3 Tm (\240)Tj 1 0 0 1 37.42 171.72 Tm (Some working practices and systems are not ensuring people's safety. Thi\ s includes )Tj 1 0 0 1 37.42 157.14 Tm (moving and handling people, ensuring windows are restricted to prevent a\ ccidental )Tj 1 0 0 1 37.42 142.56 Tm (falls, the maintenance of equipment and risk assessments and actions in \ relation to the )Tj 1 0 0 1 37.42 127.98 Tm (use of restraint. Systems are not robust enough to ensure that it is cle\ ar which staff )Tj 1 0 0 1 37.42 113.40001 Tm (have received mandatory training and which have not. The system for reco\ rding and )Tj 1 0 0 1 37.42 98.82001 Tm (monitoring accidents and incidents is not being used to help prevent fur\ ther accidents.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (The commission have not been kept informed in relation to all incidents,\ accidents and )Tj ET endstream endobj 711 0 obj 2243 endobj 712 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 148.8 w 34.57001 738.13 m 568.96997 738.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 662.60004 m 571.16998 662.60004 l S 33.45 814.72998 m 33.45 661.52997 l S 570.10004 814.72998 m 570.10004 661.52997 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (deaths in the home, as we should be so that we can monitor this type of \ activity in the )Tj 1 0 0 1 35.17 788.13995 Tm (home.)Tj 1 0 0 1 35.17 773.56 Tm (\240)Tj 1 0 0 1 35.17 758.97998 Tm (Statutory Requirement Notices have been issued to the registered owners \ of this )Tj 1 0 0 1 35.17 744.40002 Tm (service. These Notices inform the providers that they have failed to com\ ply with the )Tj 1 0 0 1 35.17 729.82001 Tm (Care Home Regulations 2001 in relation to planning people's care and in \ relation to )Tj 1 0 0 1 35.17 715.23999 Tm (meeting people's health and welfare needs. The Statutory Requirement Not\ ices tell the )Tj 1 0 0 1 35.17 700.65997 Tm (providers what they must do and gives them dates by when the failures id\ entified must )Tj 1 0 0 1 35.17 686.07996 Tm (be addressed.)Tj 1 0 0 1 35.17 671.5 Tm (\240)Tj 1 0 0 1 28.35001 648.03998 Tm (\240)Tj 1 0 0 1 28.35001 628.04999 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 628.04999 Tm (care home)Tj 1 0 0 1 480.03998 628.04999 Tm ( is taking )Tj 1 0 0 1 28.35001 610.54999 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 590.56 Tm (\240)Tj 1 0 0 1 28.35001 570.56 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 570.56 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 550.56 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 550.56 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 530.57001 Tm (order line 0870 240 7535.)Tj ET endstream endobj 713 0 obj 1804 endobj 714 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 715 0 obj 5905 endobj 716 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (Some people move into this home without having their needs fully assesse\ d and )Tj 1 0 0 1 36.62 341.25 Tm (without agreement from the funding authority. This means that people can\ not be sure )Tj 1 0 0 1 36.62 323.75998 Tm (that their needs will be met in an appropriate way or that they will be \ staying in this )Tj 1 0 0 1 36.62 306.25998 Tm (home. )Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (In surveys two out of three people who live here told us that they had t\ he information )Tj 1 0 0 1 36.57001 216.78 Tm (they needed to decide if this was the home for them. In addition, two ou\ t of three )Tj 1 0 0 1 36.57001 199.28 Tm (health care professionals say that the home's assessment arrangements us\ ually )Tj 1 0 0 1 36.57001 181.78998 Tm (ensure that accurate information is gathered and that the right service \ is planned for )Tj 1 0 0 1 36.57001 164.28999 Tm (people. One health care professional told us that this always happens.)Tj 1 0 0 1 36.57001 146.78999 Tm (\240)Tj 1 0 0 1 36.57001 129.3 Tm (We were told that the home had admitted two people to this home without \ an )Tj 1 0 0 1 36.57001 111.8 Tm (assessment by and without the agreement of the funding authority. When w\ e looked )Tj 1 0 0 1 36.57001 94.31 Tm (at records we found these people had been admitted from a residential ho\ me owned )Tj ET endstream endobj 717 0 obj 2644 endobj 718 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 336.30002 w 34.60001 643.26001 m 562.53998 643.26001 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 314.92999 w 33.47 631.44 m 563.65997 631.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 471.78 l S 564.78998 791.10999 m 564.78998 471.78 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 472.85999 m 565.87 472.85999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (by the owners of this home.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We spoke with staff who told us that one of these people had moved here \ because )Tj 1 0 0 1 34.32001 726.60999 Tm (they have nursing needs and therefore need their care to be planned and \ delivered by )Tj 1 0 0 1 34.32001 709.10999 Tm (registered nurses.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We looked at the records of one of these people. We found that an assess\ ment of their )Tj 1 0 0 1 34.32001 656.63 Tm (nursing needs had not taken place prior to their admission, or since the\ ir admission. )Tj 1 0 0 1 34.32001 639.13 Tm (We found that all assessments in their records have been carried out in \ the home they )Tj 1 0 0 1 34.32001 621.63 Tm (used to live in.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (We could not speak with this person about their feelings about the move \ as they have )Tj 1 0 0 1 34.32001 569.14996 Tm (communication difficulties. We spoke with the relative of another person\ living here. )Tj 1 0 0 1 34.32001 551.64996 Tm (They told us that they had looked around the home and at the bedroom the\ person )Tj 1 0 0 1 34.32001 534.14996 Tm (would move into. They were able to ask questions about the home before d\ eciding this )Tj 1 0 0 1 34.32001 516.65997 Tm (was the right home. However, we noted that this person's care record did\ not contain )Tj 1 0 0 1 34.32001 499.16 Tm (pre admission information from health and social care professionals as i\ t should.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj ET endstream endobj 719 0 obj 5782 endobj 720 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 403.25 m 562.53998 403.25 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 119.35001 w 33.47 392 m 563.65997 392 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 330.12 l S 564.78998 453.88 m 564.78998 330.12 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 331.20001 m 565.87 331.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (Peoples' medicines are safely managed. However, some people are being pu\ t at risk )Tj 1 0 0 1 36.62 375.25 Tm (because their health and welfare needs are not being met. People do not \ have their )Tj 1 0 0 1 36.62 357.75998 Tm (care planned in a person centred way that treats them as individuals and\ are not )Tj 1 0 0 1 36.62 340.25998 Tm (always treated with dignity. )Tj 1 0 0 1 28.35001 315.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.3 w 34.60001 193.67999 m 562.53998 193.67999 l S 1 1 1 RG 22.5 w 32.35001 296.32999 m 564.78998 296.32999 l S 201.92998 w 33.47 181.87 m 563.65997 181.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 283.95999 m 565.87 283.95999 l S 32.35001 285.04001 m 32.35001 78.70001 l S 564.78998 285.04001 m 564.78998 78.70001 l S 32.35001 283.95999 m 564.78998 283.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.26999 Tm (In surveys people living here told us they usually get the care and supp\ ort they need )Tj 1 0 0 1 36.57001 250.78 Tm (and that they always or usually get the medical support they need.)Tj 1 0 0 1 36.57001 233.28 Tm (\240)Tj 1 0 0 1 36.57001 215.78998 Tm (Two health care professionals told us that people's health care needs ar\ e always )Tj 1 0 0 1 36.57001 198.28998 Tm (properly monitored and one told us this usually happens. Two also said t\ hat the staff )Tj 1 0 0 1 36.57001 180.78998 Tm (at the home seek advice and act on it to improve well being, and one sai\ d that this )Tj 1 0 0 1 36.57001 163.3 Tm (sometimes happened. Comments from health care professionals include that\ staff act )Tj 1 0 0 1 36.57001 145.8 Tm (promptly to get medical help for people who need it and that some people\ have )Tj 1 0 0 1 36.57001 128.31 Tm (blossomed since living here.)Tj 1 0 0 1 36.57001 110.81 Tm (\240)Tj 1 0 0 1 36.57001 93.31 Tm (We looked in depth at the care plans of four people living here. We also\ looked at )Tj ET endstream endobj 721 0 obj 5378 endobj 722 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (some others. We found that each person has a plan of care and that these\ contain a )Tj 1 0 0 1 34.32001 761.60004 Tm (large number and range of documents relating to care needs. However, the\ se )Tj 1 0 0 1 34.32001 744.10999 Tm (documents were not person centred, are sometimes contradictory and do no\ t always )Tj 1 0 0 1 34.32001 726.60999 Tm (provide care staff with the detailed information that they need to meet \ people's needs.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (For example one person that we case tracked has been admitted from the o\ wners' )Tj 1 0 0 1 34.32001 674.12 Tm (residential home. This person's care plan is the care plan from that hom\ e. Staff told us )Tj 1 0 0 1 34.32001 656.63 Tm (that the reason this person was admitted to this home was because staff \ believe that )Tj 1 0 0 1 34.32001 639.13 Tm (they need the 24 hour care of nurses. However, nurses have not devised a\ care plan )Tj 1 0 0 1 34.32001 621.63 Tm (as to how this person's nursing needs are to be met. In addition, inform\ ation recorded )Tj 1 0 0 1 34.32001 604.14001 Tm (in the daily notes from the residential home has not been followed up. B\ efore being )Tj 1 0 0 1 34.32001 586.64001 Tm (admitted to this home, it was recorded that this person has a urinary ca\ theter, is )Tj 1 0 0 1 34.32001 569.14996 Tm (prone to urinary tract infections and needs encouragement to drink. Two \ days before )Tj 1 0 0 1 34.32001 551.64996 Tm (being admitted it is recorded that this person had very strong and dark \ urine which )Tj 1 0 0 1 34.32001 534.14996 Tm (means this person may not be drinking enough fluid. This person has live\ d in this care )Tj 1 0 0 1 34.32001 516.65997 Tm (home for approximately 6 weeks and the care notes have not mentioned thi\ s person's )Tj 1 0 0 1 34.32001 499.16 Tm (urine. We asked staff about this and they told us that the night staff e\ mpty the )Tj 1 0 0 1 34.32001 481.66998 Tm (catheter bag and that they didn't know how much urine this person passed\ or what )Tj 1 0 0 1 34.32001 464.16998 Tm (colour it is.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked to see how much this person drinks in a day because the reside\ ntial care )Tj 1 0 0 1 34.32001 411.67999 Tm (home instructions state that they should be encouraged to drink to preve\ nt urinary )Tj 1 0 0 1 34.32001 394.19 Tm (tract infections. We saw records that show this person drinks between 20\ 0mls and )Tj 1 0 0 1 34.32001 376.69 Tm (1050mls in a day. The records do not contain instructions about how much\ this person )Tj 1 0 0 1 34.32001 359.19 Tm (should drink in a day. We asked carers how much this person should drink\ to keep )Tj 1 0 0 1 34.32001 341.70001 Tm (them healthy and they thought that this would be about 1000mls. We asked\ carers if )Tj 1 0 0 1 34.32001 324.20001 Tm (they knew how much this person had drunk in the past days and they said \ they did )Tj 1 0 0 1 34.32001 306.70999 Tm (not because the nurse totals up the amount drunk. A nurse has reviewed t\ he records )Tj 1 0 0 1 34.32001 289.20999 Tm (kept about this person and the amount they have drunk. They record, in d\ ifferent )Tj 1 0 0 1 34.32001 271.70999 Tm (places in the care plan, that they have drunk a fair amount, small amoun\ t and a good )Tj 1 0 0 1 34.32001 254.22 Tm (amount. However, these reviews do not appear to have taken into account \ the days )Tj 1 0 0 1 34.32001 236.72 Tm (when this person has only drunk 200mls, 350mls and 400mls. We have calcu\ lated )Tj 1 0 0 1 34.32001 219.23 Tm (that this person, according to their weight, should have at least 1880ml\ s to drink each )Tj 1 0 0 1 34.32001 201.73 Tm (day. We spoke with the temporary manager about how much people should dr\ ink. She )Tj 1 0 0 1 34.32001 184.23 Tm (told us she knows there is a calculation to work this out, but does not \ know what it is. )Tj 1 0 0 1 34.32001 166.73999 Tm (We also noted that records show that this person does not have a drink b\ etween 6pm )Tj 1 0 0 1 34.32001 149.23999 Tm (and 8 or 9am. This is a very long time for someone who has a catheter an\ d is prone to )Tj 1 0 0 1 34.32001 131.75 Tm (urinary tract infections.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (We observed this person on the day of this inspection. They had numerous\ drinks put )Tj ET endstream endobj 723 0 obj 5195 endobj 724 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (in front of them by members of staff. No encouragement to drink was give\ n by staff, )Tj 1 0 0 1 34.32001 761.60004 Tm (but was given by their wife. we would estimate that this person drank ap\ proximately )Tj 1 0 0 1 34.32001 744.10999 Tm (50mls between 10am and 1pm.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We also saw that other people do not have enough to drink.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We saw in care plans that people are assessed to see if they are at risk\ of developing )Tj 1 0 0 1 34.32001 656.63 Tm (pressure sores. We saw that people we had case tracked are at risk. Thes\ e people are )Tj 1 0 0 1 34.32001 639.13 Tm (cared for on pressure relieving mattresses and cushions as is good pract\ ice. Some )Tj 1 0 0 1 34.32001 621.63 Tm (people are also nursed on adjustable beds which is also good practice. W\ e were told )Tj 1 0 0 1 34.32001 604.14001 Tm (that one person has developed a pressure sore since coming to live here \ and that one )Tj 1 0 0 1 34.32001 586.64001 Tm (person came to the home having already developed a pressure sore. We loo\ ked at )Tj 1 0 0 1 34.32001 569.14996 Tm (some pressure relieving equipment. We found one mattress had been set to\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (maximum pressure indicating that the person using this mattress is heavy\ . When we )Tj 1 0 0 1 34.32001 534.14996 Tm (looked in care records we found that this person is very light. We asked\ staff how they )Tj 1 0 0 1 34.32001 516.65997 Tm (work out the pressure that the mattress should be set to. One person sai\ d they did )Tj 1 0 0 1 34.32001 499.16 Tm (not know, another said the person setting it up does it. We looked in ca\ re plans, in )Tj 1 0 0 1 34.32001 481.66998 Tm (people's bedrooms and on the mattress motors to see if staff have access\ to )Tj 1 0 0 1 34.32001 464.16998 Tm (instructions about the pressure each mattress should be set at. We did n\ ot find any )Tj 1 0 0 1 34.32001 446.66998 Tm (instructions.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We saw in care plans that some people are at risk of malnutrition. One p\ erson we case )Tj 1 0 0 1 34.32001 394.19 Tm (tracked is losing weight. The GP has been informed. However, the recomme\ ndations )Tj 1 0 0 1 34.32001 376.69 Tm (made by the specialist nutritional tool used \(MUST\) have not been foll\ owed. According )Tj 1 0 0 1 34.32001 359.19 Tm (to this person's level of risk they should be having specific drinks to \ supplement their )Tj 1 0 0 1 34.32001 341.70001 Tm (calorie intake. Records show that these are given intermittently and not\ routinely. We )Tj 1 0 0 1 34.32001 324.20001 Tm (asked staff if this person has supplement drinks and they said no.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We noted in another person's records that they had been having loose bow\ el motions )Tj 1 0 0 1 34.32001 271.70999 Tm (and saw and heard from a relative that they had been off their food. Rec\ ords also )Tj 1 0 0 1 34.32001 254.22 Tm (show that this person has been what is described as 'grumpy'. This perso\ n has been )Tj 1 0 0 1 34.32001 236.72 Tm (weighed weekly. Although the most recent weight shows a weight gain, the\ general )Tj 1 0 0 1 34.32001 219.23 Tm (trend is that this person is losing weight. There was no record to show \ that this is )Tj 1 0 0 1 34.32001 201.73 Tm (being addressed. Staff are not keeping records of what this person eats \ and drinks. A )Tj 1 0 0 1 34.32001 184.23 Tm (nurse had recorded that they had reviewed this care plan but had not tak\ en any action )Tj 1 0 0 1 34.32001 166.73999 Tm (to address these health issues. This means that this person's health is \ not being )Tj 1 0 0 1 34.32001 149.23999 Tm (monitored appropriately and might result in a delay in appropriate actio\ n being taken.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (Prior to this inspection, the owners provided us with an updated improve\ ment plan in )Tj 1 0 0 1 34.32001 96.75 Tm (relation to requirements made at the last inspection about meeting peopl\ e's nutritional )Tj ET endstream endobj 725 0 obj 5376 endobj 726 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs. This told us that the completion of the nutritional risk assessme\ nt tool \(MUST\) )Tj 1 0 0 1 34.32001 761.60004 Tm (and for taking action if risk is identified has been designated to the c\ atering manager. )Tj 1 0 0 1 34.32001 744.10999 Tm (This person, along with other staff in the home, has received training i\ n relation to )Tj 1 0 0 1 34.32001 726.60999 Tm (nutrition from a company that supplies nutritional supplements. However,\ this does )Tj 1 0 0 1 34.32001 709.10999 Tm (not qualify them to carry out these assessments or to determine the acti\ ons that )Tj 1 0 0 1 34.32001 691.62 Tm (should be taken.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (Another care plan recorded that one person stays in bed all day and does\ not get )Tj 1 0 0 1 34.32001 639.13 Tm (dressed. It states the reason for this as them being immobile and having\ contractures )Tj 1 0 0 1 34.32001 621.63 Tm (of their legs. Records do not include evidence that consideration has be\ en given, or )Tj 1 0 0 1 34.32001 604.14001 Tm (that actions have been taken, to make arrangements or find moving and ha\ ndling )Tj 1 0 0 1 34.32001 586.64001 Tm (equipment that might allow this person to move out of their bed.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We looked at other records relating to people with dementia. Care plans \ state for )Tj 1 0 0 1 34.32001 534.14996 Tm (example, that some people have a poor mental state and reduced powers of\ )Tj 1 0 0 1 34.32001 516.65997 Tm (comprehension. However, care plans do not provide a plan as to how these\ people's )Tj 1 0 0 1 34.32001 499.16 Tm (mental health and welfare needs are to be addressed or met. In addition,\ it has been )Tj 1 0 0 1 34.32001 481.66998 Tm (agreed on three people's behalf, who are described as confused or having\ dementia, )Tj 1 0 0 1 34.32001 464.16998 Tm (that they would like to get them up as early as 6am. One of these people\ has an )Tj 1 0 0 1 34.32001 446.66998 Tm (illness the symptoms of which include stiffness, especially in the morni\ ng and fatigue. )Tj 1 0 0 1 34.32001 429.17999 Tm (These symptoms do not seem to have been considered in the decision to ge\ t them up )Tj 1 0 0 1 34.32001 411.67999 Tm (early.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We observed that one person is at high risk of choking as they have diff\ iculty )Tj 1 0 0 1 34.32001 359.19 Tm (swallowing. This person was referred to the Speech and Language Therapis\ t \(SALT\) )Tj 1 0 0 1 34.32001 341.70001 Tm (some time ago. However, a visiting health care professional observed tha\ t staff were )Tj 1 0 0 1 34.32001 324.20001 Tm (not following the guidance given by the SALT. They asked this specialist\ to visit again. )Tj 1 0 0 1 34.32001 306.70999 Tm (Instructions were left for staff to follow as to how this person is to b\ e supported to )Tj 1 0 0 1 34.32001 289.20999 Tm (eat. We saw that some of this guidance is being put into practice. Howev\ er, we also )Tj 1 0 0 1 34.32001 271.70999 Tm (saw that some is not. For example, we saw that nurses saw a visitor offe\ ring this )Tj 1 0 0 1 34.32001 254.22 Tm (person a chocolate covered wafer. They did not explain to the visitor th\ at this might )Tj 1 0 0 1 34.32001 236.72 Tm (cause problems for this person's swallowing. We saw this person in their\ wheelchair, )Tj 1 0 0 1 34.32001 219.23 Tm (leaning over to one side after lunch. This person is meant to sit up for\ 30 mins after )Tj 1 0 0 1 34.32001 201.73 Tm (eating. We saw that a member of staff put this person to bed soon after \ lunch, lying )Tj 1 0 0 1 34.32001 184.23 Tm (down. We asked staff about how this person is supported to eat and not c\ hoke. They )Tj 1 0 0 1 34.32001 166.73999 Tm (told us what they knew, but did not know that this person should be sat \ up for 30mins )Tj 1 0 0 1 34.32001 149.23999 Tm (after they had eaten. Staff told us this person has a pureed diet which \ complies with )Tj 1 0 0 1 34.32001 131.75 Tm (the SALT instructions. They also told us that they give this person cake\ and biscuits, )Tj 1 0 0 1 34.32001 114.25 Tm (which puts this person at risk of choking. The care plan does not contai\ n instructions )Tj 1 0 0 1 34.32001 96.75 Tm (for staff about what to do if this person chokes. One carer told us they\ would use their )Tj ET endstream endobj 727 0 obj 5253 endobj 728 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (common sense and try a grab and thrust movement. A nurse told us she hop\ ed that )Tj 1 0 0 1 34.32001 761.60004 Tm (staff would know to call a nurse or 999. This lack of instruction means \ that there may )Tj 1 0 0 1 34.32001 744.10999 Tm (be a delay in this person getting appropriate help.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We asked the manager how staff have been given information about this pe\ rson's )Tj 1 0 0 1 34.32001 691.62 Tm (needs and risk of choking since the most recent visit by the SALT. We we\ re told that )Tj 1 0 0 1 34.32001 674.12 Tm (the nurses had been told about the special requirements for this person,\ and the )Tj 1 0 0 1 34.32001 656.63 Tm (nurses were named, and that they give this information to the carers. We\ saw from )Tj 1 0 0 1 34.32001 639.13 Tm (the duty rota that one of these nurses had been on sick leave over this \ period. The )Tj 1 0 0 1 34.32001 621.63 Tm (manager confirmed this adding that the nurses already knew about the adv\ ice. We )Tj 1 0 0 1 34.32001 604.14001 Tm (reminded her that the SALT referral was made again because staff were no\ t following )Tj 1 0 0 1 34.32001 586.64001 Tm (the advice given, and this was putting this person at risk of choking.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We saw in the improvement plan provided by the owners that staff have ha\ d training )Tj 1 0 0 1 34.32001 534.14996 Tm (from the SALT in supporting people who have difficulties swallowing. Thi\ s document )Tj 1 0 0 1 34.32001 516.65997 Tm (also tells us that further updates will be given by the catering manager\ . This person is )Tj 1 0 0 1 34.32001 499.16 Tm (not qualified to do this and this is not good practice. We have checked \ with the SALT )Tj 1 0 0 1 34.32001 481.66998 Tm (and they have told us that they are happy to provide further training if\ needed.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We saw that many people living here have mobility problems. We checked c\ are plans )Tj 1 0 0 1 34.32001 429.17999 Tm (to see if people had had their moving and handling needs assessed. We fo\ und that )Tj 1 0 0 1 34.32001 411.67999 Tm (some people had not had these needs assessed. We found another that was \ dated )Tj 1 0 0 1 34.32001 394.19 Tm (April 2007 which had not been reviewed or updated since that time. Care \ plans give )Tj 1 0 0 1 34.32001 376.69 Tm (very general instructions for care staff such as 'needs hoist'. They did\ not specify the )Tj 1 0 0 1 34.32001 359.19 Tm (type of hoist to be used or the size of sling. We spoke to a nurse about\ how staff know )Tj 1 0 0 1 34.32001 341.70001 Tm (which hoist and sling to use. The nurse told us that if a person is on t\ he ground floor )Tj 1 0 0 1 34.32001 324.20001 Tm (they use the hoist that is on that floor and that carers make a judgment\ about what )Tj 1 0 0 1 34.32001 306.70999 Tm (size sling to use. This means that carers are not being supported to ens\ ure that they )Tj 1 0 0 1 34.32001 289.20999 Tm (use the appropriate equipment for each person.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (We also noted that the hoist is often used to help people who have been \ incontinent of )Tj 1 0 0 1 34.32001 236.72 Tm (urine. We saw that people share slings which does not help to prevent th\ e spread of )Tj 1 0 0 1 34.32001 219.23 Tm (infection and indicates that care is de-personalised.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Care plans in this home are in two parts. There is a larger comprehensiv\ e part which )Tj 1 0 0 1 34.32001 166.73999 Tm (contains details relating to the person and the plan of care. There is a\ lso a day to day )Tj 1 0 0 1 34.32001 149.23999 Tm (record which the manager told us is what carers use. Instructions in the\ se smaller )Tj 1 0 0 1 34.32001 131.75 Tm (records contain task orientated information such as needs feeding, hoist\ , weekly )Tj 1 0 0 1 34.32001 114.25 Tm (weight and on fluid chart. These are not person centred and do not give \ care staff the )Tj 1 0 0 1 34.32001 96.75 Tm (information they need to provide individualised care based on each perso\ n's individual )Tj ET endstream endobj 729 0 obj 4999 endobj 730 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs and preferences.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (Carers told us they do not tend to read care plans, although they do wri\ te in them. For )Tj 1 0 0 1 34.32001 726.60999 Tm (example they record fluid and food intake if people need to have this re\ corded. We )Tj 1 0 0 1 34.32001 709.10999 Tm (found that entries made by staff include impersonal comments such as pad\ changed, )Tj 1 0 0 1 34.32001 691.62 Tm (repositioned, soaking wet bed, usual day and nothing new. This type of l\ anguage is an )Tj 1 0 0 1 34.32001 674.12 Tm (indicator that the provision of care is task orientated and de personali\ sed.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (We asked how staff get the information they need about people and their \ needs if they )Tj 1 0 0 1 34.32001 621.63 Tm (do not read care plans. They told us they know people, or get to know th\ em. They say )Tj 1 0 0 1 34.32001 604.14001 Tm (they do not get a handover of information when they come on duty, that o\ nly the )Tj 1 0 0 1 34.32001 586.64001 Tm (nurse gets this. They say they start work straight away. They know who n\ eeds getting )Tj 1 0 0 1 34.32001 569.14996 Tm (up and who needs breakfast. We asked the temporary manager how it is ens\ ure that )Tj 1 0 0 1 34.32001 551.64996 Tm (carers have the information they need to care for people and were told t\ hat she would )Tj 1 0 0 1 34.32001 534.14996 Tm (hope nurses give this. This means there is not a robust system in place \ to ensure that )Tj 1 0 0 1 34.32001 516.65997 Tm (care staff have the information and guidance they need to ensure that pe\ ople's needs )Tj 1 0 0 1 34.32001 499.16 Tm (are met.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We saw that care plans are reviewed by nurses. However, we noted that de\ spite )Tj 1 0 0 1 34.32001 446.66998 Tm (changes in people's conditions that there were no changes to the plans o\ f care. We )Tj 1 0 0 1 34.32001 429.17999 Tm (also noted that reviews of care plans do not record what information has\ been used to )Tj 1 0 0 1 34.32001 411.67999 Tm (make the nursing decisions.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (The pharmacist inspector inspected the way that medicines are managed in\ this home. )Tj 1 0 0 1 34.32001 359.19 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 341.70001 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 324.20001 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 306.70999 Tm (were told that sometimes people can look after and take their own medici\ nes. There )Tj 1 0 0 1 34.32001 289.20999 Tm (are not any people living in the home at the moment who do this, and peo\ ple are )Tj 1 0 0 1 34.32001 271.70999 Tm (given their medicines by nursing staff.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (Medicines are stored safely for the protection of people in the home. Th\ ere are )Tj 1 0 0 1 34.32001 219.23 Tm (suitable arrangements for controlled drugs and any medicines requiring c\ old-storage.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Records are kept of medicines received into the home, and of any unwante\ d medicines )Tj 1 0 0 1 34.32001 166.73999 Tm (that are sent for destruction. Records are kept of medicines that are gi\ ven to people, )Tj 1 0 0 1 34.32001 149.23999 Tm (which helps to show that people receive their medicines as prescribed by\ the doctor. If )Tj 1 0 0 1 34.32001 131.75 Tm (a regularly prescribed dose is omitted, then a reason for this is record\ ed, as is good )Tj 1 0 0 1 34.32001 114.25 Tm (practice. Usually if a variable dose is prescribed there are clear recor\ ds to show how )Tj 1 0 0 1 34.32001 96.75 Tm (much is given, and this too is good practice.)Tj ET endstream endobj 731 0 obj 4862 endobj 732 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 686.21997 w 34.60001 468.30002 m 562.53998 468.30002 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 664.84998 w 33.47 456.47998 m 563.65997 456.47998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 121.86 l S 564.78998 791.10999 m 564.78998 121.86 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 122.93001 m 565.87 122.93001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We looked at some people's care plans to see what information is recorde\ d about their )Tj 1 0 0 1 34.32001 744.10999 Tm (medicines. We found written permission from the doctor to crush someone'\ s tablets )Tj 1 0 0 1 34.32001 726.60999 Tm (before giving. Staff had not asked if other forms of the same medicines \ are available, )Tj 1 0 0 1 34.32001 709.10999 Tm (such as soluble tablets or liquids, to make it easier for people to take\ . We found clear )Tj 1 0 0 1 34.32001 691.62 Tm (guidance for staff on when to administer medication that was prescribed \ to be given )Tj 1 0 0 1 34.32001 674.12 Tm ('when required'. This helps to show that people receive their medicines \ in the way )Tj 1 0 0 1 34.32001 656.63 Tm (their doctor intended for them.)Tj 1 0 0 1 34.32001 639.13 Tm (\240)Tj 1 0 0 1 34.32001 621.63 Tm (We looked at how people's privacy and dignity is maintained. We heard pe\ ople being )Tj 1 0 0 1 34.32001 604.14001 Tm (called by their preferred names and some people were able to tell us the\ y wear their )Tj 1 0 0 1 34.32001 586.64001 Tm (own clothes. We saw staff discreetly helping some people go to the toile\ t. However, )Tj 1 0 0 1 34.32001 569.14996 Tm (we also saw one person trying to attract the attention of staff who walk\ ed past or said )Tj 1 0 0 1 34.32001 551.64996 Tm ('hang on' as they walked past and did not come back. We heard one person\ saying no )Tj 1 0 0 1 34.32001 534.14996 Tm (repeatedly and we heard a carer saying 'yes, yes, yes' in a mocking fash\ ion.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We saw in the care plans of two people that they like to be or are washe\ d, shaved, )Tj 1 0 0 1 34.32001 481.66998 Tm (have their hair brushed and dressed whilst sitting on the commode. This \ is not a )Tj 1 0 0 1 34.32001 464.16998 Tm (dignified way to provide care. In addition a record of names of people w\ ho had taken )Tj 1 0 0 1 34.32001 446.66998 Tm (a bath is kept in the communal bathroom. This indicates an institutional\ approach to )Tj 1 0 0 1 34.32001 429.17999 Tm (people's personal care needs and to their confidentiality.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (We saw one person being hoisted to be taken to the toilet. When raised o\ ut of their )Tj 1 0 0 1 34.32001 376.69 Tm (seat there was a strong smell of urine. After they left the lounge, the \ smell persisted. )Tj 1 0 0 1 34.32001 359.19 Tm (We smelt the chair and found that the smell was coming from the fabric o\ f the chair, )Tj 1 0 0 1 34.32001 341.70001 Tm (and from the pressure relieving cushion on the chair. When staff returne\ d they put )Tj 1 0 0 1 34.32001 324.20001 Tm (this person back onto the chair. Each time this person shifted their wei\ ght in their )Tj 1 0 0 1 34.32001 306.70999 Tm (chair, there was an unpleasant odour of stale urine released.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj 1 0 0 1 34.32001 271.70999 Tm (We saw that two people share a bedroom. There are no records to show tha\ t each )Tj 1 0 0 1 34.32001 254.22 Tm (person has been consulted or made an informed choice about this, as shou\ ld happen. )Tj 1 0 0 1 34.32001 236.72 Tm (We saw that the room can be divided by a curtain. When we asked one pers\ on if this )Tj 1 0 0 1 34.32001 219.23 Tm (was used, they told us that it isn't always. Although this person says t\ hey don't mind, )Tj 1 0 0 1 34.32001 201.73 Tm (it is unclear what the other person sharing this room thinks or feels ab\ out this as they )Tj 1 0 0 1 34.32001 184.23 Tm (have communication difficulties.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (One health care professional commented that sometimes shared rooms creat\ e )Tj 1 0 0 1 34.32001 131.75 Tm (problems around privacy and dignity. )Tj ET endstream endobj 733 0 obj 5858 endobj 734 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 437.25 m 562.53998 437.25 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 119.35001 w 33.47 426 m 563.65997 426 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87991 m 32.35001 364.12 l S 564.78998 487.87991 m 564.78998 364.12 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 365.20001 m 565.87 365.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Some people's quality of life is enhanced by continued links with their \ families and )Tj 1 0 0 1 36.62 409.25 Tm (friends and by the activities they take part in. However, not everyone i\ s having their )Tj 1 0 0 1 36.62 391.75998 Tm (individual social needs and rights to make choices met.)Tj 1 0 0 1 36.62 374.25998 Tm (People enjoy an appetising, balanced diet that meets their nutritional n\ eeds.)Tj 1 0 0 1 28.35001 349.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 257.30002 w 34.60001 210.67998 m 562.53998 210.67998 l S 1 1 1 RG 22.5 w 32.35001 330.32999 m 564.78998 330.32999 l S 235.92998 w 33.47 198.87 m 563.65997 198.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 317.95999 m 565.87 317.95999 l S 32.35001 319.03998 m 32.35001 78.70001 l S 564.78998 319.03998 m 564.78998 78.70001 l S 32.35001 317.95999 m 564.78998 317.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 327.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 302.26999 Tm (Since the last inspection the home has employed an activities co-ordinat\ or for 20 )Tj 1 0 0 1 36.57001 284.78 Tm (hours each week. This person is responsible for meeting the social needs\ of all the )Tj 1 0 0 1 36.57001 267.28 Tm (people living here and provides support with helping people to eat and w\ ith personal )Tj 1 0 0 1 36.57001 249.78998 Tm (care such as cutting people's nails.)Tj 1 0 0 1 36.57001 232.28998 Tm (\240)Tj 1 0 0 1 36.57001 214.78998 Tm (In surveys people told us there are usually activities they can take par\ t in if they want )Tj 1 0 0 1 36.57001 197.3 Tm (to. We saw that about 4 people who spend their time in the lounge are we\ ll attended )Tj 1 0 0 1 36.57001 179.8 Tm (to. We saw people took part in a picture quiz, in card games and in phys\ ical activity. )Tj 1 0 0 1 36.57001 162.31 Tm (These people were having fun, were being included, were relaxed and were\ treated )Tj 1 0 0 1 36.57001 144.81 Tm (with respect and with warmth. We saw that one person in particular is re\ ally )Tj 1 0 0 1 36.57001 127.31 Tm (benefiting from having this social interaction.)Tj 1 0 0 1 36.57001 109.82001 Tm (\240)Tj 1 0 0 1 36.57001 92.32001 Tm (We also saw the the lounge is laid out in such a way that separate areas\ have been )Tj ET endstream endobj 735 0 obj 4934 endobj 736 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (created. This means that people can take part in different activities or\ have )Tj 1 0 0 1 34.32001 761.60004 Tm (conversations without disturbing anyone else, and away from the televisi\ on. The )Tj 1 0 0 1 34.32001 744.10999 Tm (television was on throughout the day during this inspection. It was set \ to a very high )Tj 1 0 0 1 34.32001 726.60999 Tm (volume and no one was watching it. One person did take an interest when \ the )Tj 1 0 0 1 34.32001 709.10999 Tm (lunchtime news came on. They told us they like to hear the news, but tha\ t they're not )Tj 1 0 0 1 34.32001 691.62 Tm (bothered otherwise.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We saw one person enjoying knitting who also benefited from the activiti\ es organised. )Tj 1 0 0 1 34.32001 639.13 Tm (Other people were invited to join in and declined or were unable to do s\ o due to their )Tj 1 0 0 1 34.32001 621.63 Tm (disabilities.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (Other people living in this home spend time in their rooms. We spoke wit\ h staff about )Tj 1 0 0 1 34.32001 569.14996 Tm (how these people are supported to have their social needs met. We were t\ old the )Tj 1 0 0 1 34.32001 551.64996 Tm (activities co-ordinator spends time with these people in their rooms. We\ found that, )Tj 1 0 0 1 34.32001 534.14996 Tm (whilst well intentioned and very skillful, this person cannot meet the s\ ocial needs of all )Tj 1 0 0 1 34.32001 516.65997 Tm (the people living here. People who are physically or mentally disabled s\ pend long )Tj 1 0 0 1 34.32001 499.16 Tm (periods alone.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (One person told us they get bored lying in bed all day. Their relative s\ aid that staff )Tj 1 0 0 1 34.32001 446.66998 Tm (come into the room, but that this is to carry out care tasks such as tur\ ning. The care )Tj 1 0 0 1 34.32001 429.17999 Tm (plan for this person does not contain any information about their intere\ sts or religious )Tj 1 0 0 1 34.32001 411.67999 Tm (or spiritual needs.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Other care plans contain some information about people's interests. Howe\ ver, )Tj 1 0 0 1 34.32001 359.19 Tm (knowledge about these interests is not being used to meet each person's \ need to be )Tj 1 0 0 1 34.32001 341.70001 Tm (engaged and be social in an individualised way.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (For example each care plan has sections about people's spiritual needs. \ The care plan )Tj 1 0 0 1 34.32001 289.20999 Tm (of one person who has dementia states they are very religious and identi\ fies their )Tj 1 0 0 1 34.32001 271.70999 Tm (religion. The care plan section relating to social needs records that th\ is person loves to )Tj 1 0 0 1 34.32001 254.22 Tm (go out. The care plan does not identify how this person will be supporte\ d to attend a )Tj 1 0 0 1 34.32001 236.72 Tm (religious service or how they will be helped to go out. Staff tell us th\ is person does not )Tj 1 0 0 1 34.32001 219.23 Tm (go to church and does not go out. In addition, the part of the care plan\ relating to )Tj 1 0 0 1 34.32001 201.73 Tm (people's death and dying needs states that this person should be encoura\ ged to )Tj 1 0 0 1 34.32001 184.23 Tm (express their wishes regarding death as it approaches. This statement is\ used in all )Tj 1 0 0 1 34.32001 166.73999 Tm (the care plans we looked at where the section on death and dying had bee\ n )Tj 1 0 0 1 34.32001 149.23999 Tm (completed. This person's plan makes no mention of the arrangements this \ person )Tj 1 0 0 1 34.32001 131.75 Tm (might like in relation to their religion.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (Another person's care plan does not identify their social interests and \ we saw that this )Tj ET endstream endobj 737 0 obj 5000 endobj 738 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (person spent the day at the home in the lounge without being engaged in \ any activity.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We asked staff how decisions are made about who gets up early or late. S\ taff told us )Tj 1 0 0 1 34.32001 726.60999 Tm ('the diabetics are always got up first and that after that it depends on\ where the )Tj 1 0 0 1 34.32001 709.10999 Tm (member of staff decides to start work'. This indicates that people are n\ ot offered )Tj 1 0 0 1 34.32001 691.62 Tm (choice.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We found that the care plan for one person contains a recently written s\ tatement that )Tj 1 0 0 1 34.32001 639.13 Tm (they like to get up at 6am. It also states that the nurse writing this h\ as discussed this )Tj 1 0 0 1 34.32001 621.63 Tm (with the person and that they agree with this. This person is described \ in the care plan )Tj 1 0 0 1 34.32001 604.14001 Tm (as having dementia and being confused. We found this statement in the ca\ re plan of )Tj 1 0 0 1 34.32001 586.64001 Tm (another person who is also described as having dementia. This means that\ people who )Tj 1 0 0 1 34.32001 569.14996 Tm (cannot speak up for themselves do not make decisions and do not have con\ trol over )Tj 1 0 0 1 34.32001 551.64996 Tm (their individual daily lives.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj 1 0 0 1 34.32001 516.65997 Tm (Visitors told us they can visit when they like. And we saw visitors in t\ he home at )Tj 1 0 0 1 34.32001 499.16 Tm (different times of the day and evening. Some people say that staff keep \ them up to )Tj 1 0 0 1 34.32001 481.66998 Tm (date with changes and developments and others say that staff don't do th\ is.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (In surveys people told us they always like the food served in the home. \ People we )Tj 1 0 0 1 34.32001 429.17999 Tm (spoke with say they like the variety and the quality of food served. We \ heard staff )Tj 1 0 0 1 34.32001 411.67999 Tm (asking people what they would like for lunch, close to the time this was\ being served. )Tj 1 0 0 1 34.32001 394.19 Tm (This means that people are helped to make a choice about what to eat at \ a time when )Tj 1 0 0 1 34.32001 376.69 Tm (they are ready to make this decision and when it means something to them\ . We were )Tj 1 0 0 1 34.32001 359.19 Tm (unsure how staff helped people who cannot speak for themselves to make d\ ecisions )Tj 1 0 0 1 34.32001 341.70001 Tm (about what to eat. We asked a member of care staff who told us that they\ get to know )Tj 1 0 0 1 34.32001 324.20001 Tm (what people like. We saw in care plans that there are records about some\ people's )Tj 1 0 0 1 34.32001 306.70999 Tm (likes and dislikes, but not for all people. We saw records relating to w\ hat one person )Tj 1 0 0 1 34.32001 289.20999 Tm (eats. We saw that they have porridge for breakfast every day as far back\ as we saw )Tj 1 0 0 1 34.32001 271.70999 Tm (records for \(approximately 11 weeks\). They had also had scrambled egg \ for supper for )Tj 1 0 0 1 34.32001 254.22 Tm (the majority of those 11 weeks. Staff told us that this person sometimes\ does not eat )Tj 1 0 0 1 34.32001 236.72 Tm (much at supper and on the day of this inspection staff told us this pers\ on only ate 2 )Tj 1 0 0 1 34.32001 219.23 Tm (small spoonfuls of supper. The records and conversations with staff do n\ ot indicate )Tj 1 0 0 1 34.32001 201.73 Tm (that staff had explored the possibility that this person might be bored \ with their )Tj 1 0 0 1 34.32001 184.23 Tm (supper diet.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We heard that one person who spends all their time in their bedroom had \ not had )Tj 1 0 0 1 34.32001 131.75 Tm (breakfast on two occasions and that their morning tea had been missed a \ couple of )Tj 1 0 0 1 34.32001 114.25 Tm (times.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 739 0 obj 1224 endobj 740 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We also saw two people being supported to eat by staff whilst in their b\ edrooms. The )Tj 1 0 0 1 34.32001 761.60004 Tm (support given was unhurried, relaxed and sensitive. )Tj ET endstream endobj 741 0 obj 5679 endobj 742 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 505.73999 m 562.53998 505.73999 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 84.36 w 33.47 494.5 m 563.65997 494.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 450.12 l S 564.78998 538.88 m 564.78998 450.12 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 451.19 m 565.87 451.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People concerns are not always acted upon and people are not fully safeg\ uarded from )Tj 1 0 0 1 36.62 460.25 Tm (harm. )Tj 1 0 0 1 28.35001 435.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 343.30002 w 34.60001 253.67 m 562.53998 253.67 l S 1 1 1 RG 22.5 w 32.35001 416.31998 m 564.78998 416.31998 l S 321.92999 w 33.47 241.86 m 563.65997 241.86 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 403.94998 m 565.87 403.94998 l S 32.35001 405.03 m 32.35001 78.70001 l S 564.78998 405.03 m 564.78998 78.70001 l S 32.35001 403.94998 m 564.78998 403.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 413.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 388.26999 Tm (In surveys all 3 people told us that they know how to make a formal comp\ laint and 2 )Tj 1 0 0 1 36.57001 370.76999 Tm (told us there is someone they can speak with informally if they are not \ happy. One )Tj 1 0 0 1 36.57001 353.26999 Tm (person said they can only do this with their visitors.)Tj 1 0 0 1 36.57001 335.78 Tm (\240)Tj 1 0 0 1 36.57001 318.28 Tm (The information given to us in the AQAA tells us that this home has rece\ ived one )Tj 1 0 0 1 36.57001 300.78998 Tm (complaint since the last inspection a year ago. This was dealt with by t\ he home within )Tj 1 0 0 1 36.57001 283.29001 Tm (28 days, which is the timescale set, and it was upheld. It also tells us\ that one )Tj 1 0 0 1 36.57001 265.79001 Tm (safeguarding alert was made alleging that someone living at the home was\ not )Tj 1 0 0 1 36.57001 248.3 Tm (receiving care that was safe. This was investigated by the safeguarding \ team in May )Tj 1 0 0 1 36.57001 230.8 Tm (2009. The outcome of this was that the care provided was not neglectful \ or abusive, )Tj 1 0 0 1 36.57001 213.31 Tm (but was poor practice.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Since then the commission has received two complaints about the quality \ of care, )Tj 1 0 0 1 36.57001 160.81999 Tm (about staff not being available when needed, about the management of med\ icines and )Tj 1 0 0 1 36.57001 143.31999 Tm (about the general management of the home. One person said they had bough\ t their )Tj 1 0 0 1 36.57001 125.83 Tm (concerns to the attention of staff but did not get a satisfactory respon\ se. Another )Tj 1 0 0 1 36.57001 108.33 Tm (person said they thought that staff were not taking their concerns serio\ usly enough.)Tj 1 0 0 1 36.57001 90.83 Tm (\240)Tj ET endstream endobj 743 0 obj 5335 endobj 744 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We have looked at some of these issues during this inspection and are wo\ rking with )Tj 1 0 0 1 34.32001 761.60004 Tm (the safeguarding team who are undertaking an investigation relating to t\ hese )Tj 1 0 0 1 34.32001 744.10999 Tm (allegations. In addition Devon County Council are reviewing the care of \ the people )Tj 1 0 0 1 34.32001 726.60999 Tm (living here.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (The AQAA tells us that no one living here is subject to any form of rest\ raint. However, )Tj 1 0 0 1 34.32001 674.12 Tm (a referral was made under the Deprivation of Liberty and Mental Capacity\ Act because )Tj 1 0 0 1 34.32001 656.63 Tm (one person is being restrained in their wheelchair. This is not a depriv\ ation of liberty )Tj 1 0 0 1 34.32001 639.13 Tm (but is a form of restraint. We saw that this continues. We also saw in a\ care plan that )Tj 1 0 0 1 34.32001 621.63 Tm (another person is restrained in their chair by using a lap belt when the\ y try to stand )Tj 1 0 0 1 34.32001 604.14001 Tm (up. We saw that people have bed rails whilst in their beds, which is ano\ ther form of )Tj 1 0 0 1 34.32001 586.64001 Tm (restraint. There is some indication that the restraint used for people w\ hilst sitting in )Tj 1 0 0 1 34.32001 569.14996 Tm (their chairs might not always be appropriate. This is because records st\ ate that it is )Tj 1 0 0 1 34.32001 551.64996 Tm (used when people try to stand up or get agitated. The use of restraint i\ s sometimes )Tj 1 0 0 1 34.32001 534.14996 Tm (the only action that can be taken to keep someone safe. However, records\ should )Tj 1 0 0 1 34.32001 516.65997 Tm (show that all other actions to reduce risk have been tried before this a\ ction is taken. )Tj 1 0 0 1 34.32001 499.16 Tm (In addition, care plans do not give clear and specific instructions as t\ o when restraint )Tj 1 0 0 1 34.32001 481.66998 Tm (should be used and for how long. We asked staff about the use of restrai\ nt in the form )Tj 1 0 0 1 34.32001 464.16998 Tm (of a lap belt for one person. They told us that they use it only when ne\ eded, when )Tj 1 0 0 1 34.32001 446.66998 Tm (staff are not around, and for a few hours. This means that restraint is \ being used for )Tj 1 0 0 1 34.32001 429.17999 Tm (long periods when staff are not around to supervise vulnerable and agita\ ted people.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (People who live here are having decisions about forms of restraint made \ by staff or )Tj 1 0 0 1 34.32001 376.69 Tm (relatives. Sometimes this has to happen if the person involved is not ab\ le to make )Tj 1 0 0 1 34.32001 359.19 Tm (these decisions for themselves. The circumstances of these decisions sho\ uld be )Tj 1 0 0 1 34.32001 341.70001 Tm (recorded so that it is clear that these decisions are being made in the \ best interests of )Tj 1 0 0 1 34.32001 324.20001 Tm (that person. Such records are not being kept for people living in this h\ ome.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We saw three people who have bruises or broken skin. We asked staff abou\ t these. )Tj 1 0 0 1 34.32001 271.70999 Tm (They gave us explanations for two but staff did not know what had caused\ the third )Tj 1 0 0 1 34.32001 254.22 Tm (injury. We saw in care records that one person's injury had been caused \ when they )Tj 1 0 0 1 34.32001 236.72 Tm (had resisted care. The circumstances of this have not been investigated \ and actions )Tj 1 0 0 1 34.32001 219.23 Tm (have not been taken to prevent this happening again. Another person inju\ red them )Tj 1 0 0 1 34.32001 201.73 Tm (self on a bed rail and there are no records to show that actions have be\ en taken to )Tj 1 0 0 1 34.32001 184.23 Tm (prevent this happening again.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We spoke with staff about what they would do if they saw or suspected ab\ use. They )Tj 1 0 0 1 34.32001 131.75 Tm (told us they would tell the nurse in charge, as is good practice. We ask\ ed the nurse in )Tj 1 0 0 1 34.32001 114.25 Tm (charge what they would do, and the actions they describe are contrary to\ the guidance )Tj 1 0 0 1 34.32001 96.75 Tm (given in the multi-agency guidance. This person told us that they had re\ ceived )Tj ET endstream endobj 745 0 obj 1252 endobj 746 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (training and had a copy of the guidance in the home. However, the guidan\ ce they )Tj 1 0 0 1 34.32001 761.60004 Tm (showed us would not guide them to take appropriate action if abuse were \ suspected. )Tj ET endstream endobj 747 0 obj 5720 endobj 748 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 488.73999 m 562.53998 488.73999 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 84.36 w 33.47 477.5 m 563.65997 477.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 433.12 l S 564.78998 521.88 m 564.78998 433.12 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 434.19 m 565.87 434.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (People living here enjoy a homely environment. However, improvements are\ needed )Tj 1 0 0 1 36.62 443.25 Tm (to ensure that people are fully protected from infection. )Tj 1 0 0 1 28.35001 418.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 326.30002 w 34.60001 245.17 m 562.53998 245.17 l S 1 1 1 RG 22.5 w 32.35001 399.31998 m 564.78998 399.31998 l S 304.92999 w 33.47 233.36 m 563.65997 233.36 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 386.94998 m 565.87 386.94998 l S 32.35001 388.03 m 32.35001 78.70001 l S 564.78998 388.03 m 564.78998 78.70001 l S 32.35001 386.94998 m 564.78998 386.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 396.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 371.26999 Tm (In surveys people told us that the home is usually clean and fresh. On t\ he day we )Tj 1 0 0 1 36.57001 353.76999 Tm (visited we found it to be clean and odour free.)Tj 1 0 0 1 36.57001 336.26999 Tm (\240)Tj 1 0 0 1 36.57001 318.78 Tm (The home is warm, and is furnished and decorated in a domestic and homel\ y style. )Tj 1 0 0 1 36.57001 301.28 Tm (There is a reception area in the large hall, where there is usually a me\ mber of staff )Tj 1 0 0 1 36.57001 283.79001 Tm (during the day so that people visiting the home can speak with them. The\ re is also a )Tj 1 0 0 1 36.57001 266.29001 Tm (large board in the hall displaying the photographs and names of the staf\ f working at )Tj 1 0 0 1 36.57001 248.78998 Tm (the home. This is helpful so that people can identify and become familia\ r with staff.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The home has one large lounge and a dining room. Both are decorated and \ furnished )Tj 1 0 0 1 36.57001 196.31 Tm (in a homely style. The tables in the dining room are smaller and this he\ lps people to )Tj 1 0 0 1 36.57001 178.81 Tm (sit in smaller groups and to experience meals as a social occasion. The \ lounge is )Tj 1 0 0 1 36.57001 161.31 Tm (divided into smaller seating areas so that people can carry out differen\ t activities )Tj 1 0 0 1 36.57001 143.81999 Tm (without disturbing others. This area is very bright as it has large wind\ ows to the side )Tj 1 0 0 1 36.57001 126.32001 Tm (and rear of the house.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (We saw staff washing their hands and wearing protective clothing as a wa\ y of helping )Tj ET endstream endobj 749 0 obj 2517 endobj 750 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (to prevent the spread of infection. Staff use alcohol gel as another way\ of preventing )Tj 1 0 0 1 34.32001 761.60004 Tm (the spread of infection, and this is also available for visitors to the \ home to use.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we saw that the sluice did not have liquid soap for staff to wa\ sh their hands, )Tj 1 0 0 1 34.32001 709.10999 Tm (and that some soap dispensers appear dirty and one was empty.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last inspection by the commission the home have also been visi\ ted by the )Tj 1 0 0 1 34.32001 656.63 Tm (fire authority. Some actions were required and these have been carried o\ ut. We saw )Tj 1 0 0 1 34.32001 639.13 Tm (that access from the home is controlled at the front door by a key pad s\ ystem and )Tj 1 0 0 1 34.32001 621.63 Tm (were told that this is linked to the fire alarm. This means that when th\ e fire alarm )Tj 1 0 0 1 34.32001 604.14001 Tm (sounds that the door lock will automatically be opened, and is good prac\ tice.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We were told that some areas of the home have been redecorated. We saw o\ ne )Tj 1 0 0 1 34.32001 551.64996 Tm (upstairs window being replaced. We saw that staff test and record the te\ mperature of )Tj 1 0 0 1 34.32001 534.14996 Tm (bathing water as is good practice to ensure that accidental scalding is \ prevented. )Tj ET endstream endobj 751 0 obj 5784 endobj 752 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 480 m 562.53998 480 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 101.85001 w 33.47 468.75 m 563.65997 468.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 415.62 l S 564.78998 521.88 m 564.78998 415.62 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 416.70001 m 565.87 416.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (There are not always enough staff on duty with the appropriate qualifica\ tions, training )Tj 1 0 0 1 36.62 443.25 Tm (and skills to care for people living here. Practices in relation to recr\ uitment are placing )Tj 1 0 0 1 36.62 425.75998 Tm (people at risk of harm. )Tj 1 0 0 1 28.35001 401.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 308.80002 w 34.60001 236.42998 m 562.53998 236.42998 l S 1 1 1 RG 22.5 w 32.35001 381.82999 m 564.78998 381.82999 l S 287.42999 w 33.47 224.62 m 563.65997 224.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 369.44998 m 565.87 369.44998 l S 32.35001 370.53 m 32.35001 78.70001 l S 564.78998 370.53 m 564.78998 78.70001 l S 32.35001 369.44998 m 564.78998 369.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 378.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 353.76999 Tm (This is a nursing home and should have a registered nurse on duty throug\ hout the day )Tj 1 0 0 1 36.57001 336.26999 Tm (and night. We were contacted by a person who was concerned this was not \ )Tj 1 0 0 1 36.57001 318.78 Tm (happening. We contacted the home and it was confirmed that on one night \ there was )Tj 1 0 0 1 36.57001 301.28 Tm (not a nurse on duty. We asked the owner why they had not used an agency \ nurse to )Tj 1 0 0 1 36.57001 283.79001 Tm (cover this shift. They told us that this home never uses agency staff. T\ hey told us that )Tj 1 0 0 1 36.57001 266.29001 Tm (due to staff sickness they had arranged for a nurse to sleep at the home\ on that night. )Tj 1 0 0 1 36.57001 248.78998 Tm (This practice puts people at risk.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The caller was also concerned that there are not enough staff on duty. W\ e spoke to )Tj 1 0 0 1 36.57001 196.31 Tm (the owner about this. She told us that staffing has been reduced but tha\ t there are )Tj 1 0 0 1 36.57001 178.81 Tm (enough staff on duty to meet people's current needs. We looked at the du\ ty rota and )Tj 1 0 0 1 36.57001 161.31 Tm (saw that there had previously been 3 or 4 carers on duty in the morning \ and this had )Tj 1 0 0 1 36.57001 143.81999 Tm (been reduced to 2 or 3 carers. In the afternoon we saw that there used t\ o be 2 or 3 )Tj 1 0 0 1 36.57001 126.32001 Tm (carers on duty in the afternoon, and now there are 2. On the day of this\ inspection )Tj 1 0 0 1 36.57001 108.83 Tm (there was a nurse on duty with 3 carers, an administrator, cook and the \ temporary )Tj 1 0 0 1 36.57001 91.33 Tm (manager.)Tj ET endstream endobj 753 0 obj 4923 endobj 754 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We saw in the information given to us by the home prior to the inspectio\ n that there )Tj 1 0 0 1 34.32001 744.10999 Tm (are 14 people living at the home who need help with undressing and dress\ ing, and )Tj 1 0 0 1 34.32001 726.60999 Tm (need help to go to the toilet. 11 people are incontinent of both faeces \ and urine and 8 )Tj 1 0 0 1 34.32001 709.10999 Tm (people have dementia. 11 people need two members of staff to help them w\ ith their )Tj 1 0 0 1 34.32001 691.62 Tm (care.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (In surveys one person told us that staff are usually available, one that\ staff are )Tj 1 0 0 1 34.32001 639.13 Tm (sometimes available and one that staff are never available when needed. \ Comments )Tj 1 0 0 1 34.32001 621.63 Tm (included staff are not always available, and the home is very short of s\ taff. The )Tj 1 0 0 1 34.32001 604.14001 Tm (surveys also asked what the home could do better. People said employ mor\ e staff who )Tj 1 0 0 1 34.32001 586.64001 Tm (can speak and understand English and train and employ more staff especia\ lly at night. )Tj 1 0 0 1 34.32001 569.14996 Tm (Staff were however described as nice and lovely.)Tj 1 0 0 1 34.32001 551.64996 Tm (\240)Tj 1 0 0 1 34.32001 534.14996 Tm (We looked at the records relating to falls and injuries. According to th\ ese records )Tj 1 0 0 1 34.32001 516.65997 Tm (people have been found to have fallen when there have been no staff pres\ ent on 14 )Tj 1 0 0 1 34.32001 499.16 Tm (separate occasions since the beginning of July this year. This means tha\ t people are )Tj 1 0 0 1 34.32001 481.66998 Tm (not being sufficiently supervised by staff to keep them safe.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We know that these accident records are incomplete. We are aware that on\ e person )Tj 1 0 0 1 34.32001 429.17999 Tm (has fallen whilst alone, and this is not recorded. We also saw that two \ people had )Tj 1 0 0 1 34.32001 411.67999 Tm (injuries which have not been recorded as accidents or incidents.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We looked at the duty rota and found that is is not always accurate. For\ example, on )Tj 1 0 0 1 34.32001 359.19 Tm (some weeks the manager, who has left the home, is recorded as on duty. I\ n addition, )Tj 1 0 0 1 34.32001 341.70001 Tm (the temporary manager has not been included on the duty rota until Septe\ mber )Tj 1 0 0 1 34.32001 324.20001 Tm (although they say they started work at the home in August.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We asked to see the records of staff training. We were told that these a\ re incomplete )Tj 1 0 0 1 34.32001 271.70999 Tm (because the records about training have gone missing since the manager l\ eft the )Tj 1 0 0 1 34.32001 254.22 Tm (home. We saw that some records had been made about training, but that th\ ere were )Tj 1 0 0 1 34.32001 236.72 Tm (large gaps. The management team tell us that this means they are not ful\ ly aware of )Tj 1 0 0 1 34.32001 219.23 Tm (what training staff have had, and what training might be needed. We did \ see a notice )Tj 1 0 0 1 34.32001 201.73 Tm (that said that training has been arranged for staff in relation preventi\ ng people from )Tj 1 0 0 1 34.32001 184.23 Tm (falling.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (Staff told us they had had some training. One told us they had had train\ ing in how to )Tj 1 0 0 1 34.32001 131.75 Tm (provide care to people, another that they thought they had had training \ in relation to )Tj 1 0 0 1 34.32001 114.25 Tm (supporting people who have problems with swallowing. However, they went \ on to )Tj 1 0 0 1 34.32001 96.75 Tm (describe training which relates to nutritional supplements. One person t\ hought they )Tj ET endstream endobj 755 0 obj 2380 endobj 756 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 266.32001 w 34.60001 678.25 m 562.53998 678.25 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 244.93999 w 33.47 666.44 m 563.65997 666.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 541.76001 l S 564.78998 791.10999 m 564.78998 541.76001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 542.83997 m 565.87 542.83997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (had had training about dementia, and gave a description of how to care f\ or someone )Tj 1 0 0 1 34.32001 761.60004 Tm (with dementia which was an example of good practice.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we also saw that staff record that people have drunk more than \ they have. )Tj 1 0 0 1 34.32001 709.10999 Tm (We heard staff trying to persuade a confused person that their understan\ ding of a )Tj 1 0 0 1 34.32001 691.62 Tm (situation was wrong, causing distress and confusion to this person. We a\ lso saw staff )Tj 1 0 0 1 34.32001 674.12 Tm (ignoring one person who was trying to attract their attention.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (The AQAA told us that 10 of the 12 carers working at this home have achi\ eved a )Tj 1 0 0 1 34.32001 621.63 Tm (National Vocational Qualification \(NVQ\) in care, to level 2 or above. \ We asked the )Tj 1 0 0 1 34.32001 604.14001 Tm (manager if there is a system in place to ensure that staff practice the \ skills they are )Tj 1 0 0 1 34.32001 586.64001 Tm (taught, and to ensure they do this to the level of quality that is expec\ ted. The )Tj 1 0 0 1 34.32001 569.14996 Tm (manager told us that this is the nurses responsibility and that there is\ no formal )Tj 1 0 0 1 34.32001 551.64996 Tm (system.)Tj ET endstream endobj 757 0 obj 5831 endobj 758 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 395 m 562.53998 395 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 101.85001 w 33.47 383.75 m 563.65997 383.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 330.62 l S 564.78998 436.88 m 564.78998 330.62 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 331.70001 m 565.87 331.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of leadership in this home means that systems are not in place to e\ nsure that )Tj 1 0 0 1 36.62 358.25 Tm (people receive the care they need to an acceptable standard in a way tha\ t promotes )Tj 1 0 0 1 36.62 340.75998 Tm (their safety. )Tj 1 0 0 1 28.35001 316.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.8 w 34.60001 193.92999 m 562.53998 193.92999 l S 1 1 1 RG 22.5 w 32.35001 296.82999 m 564.78998 296.82999 l S 202.42998 w 33.47 182.12 m 563.65997 182.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 284.44998 m 565.87 284.44998 l S 32.35001 285.53 m 32.35001 78.70001 l S 564.78998 285.53 m 564.78998 78.70001 l S 32.35001 284.44998 m 564.78998 284.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.76999 Tm (This home does not have a Registered Manager. The previous manager left \ in August )Tj 1 0 0 1 36.57001 251.26999 Tm (2009. Since that time the home has been managed on a temporary basis. Th\ e )Tj 1 0 0 1 36.57001 233.78 Tm (temporary manager is a Registered Nurse and is studying for a Leadership\ and )Tj 1 0 0 1 36.57001 216.28 Tm (Management qualification. She had been working as the \(unregistered\) m\ anager of )Tj 1 0 0 1 36.57001 198.78998 Tm (the owners' residential home, and works from 9am - 3pm four days weekly.\ She is )Tj 1 0 0 1 36.57001 181.28998 Tm (supernumerary to nursing hours and is supported by two of the four owner\ s of this )Tj 1 0 0 1 36.57001 163.78999 Tm (home, who are also nurses.)Tj 1 0 0 1 36.57001 146.3 Tm (\240)Tj 1 0 0 1 36.57001 128.8 Tm (In the last few months the commission has received comments from relativ\ es of )Tj 1 0 0 1 36.57001 111.31 Tm (people living here who say the overall management of the home has declin\ ed. One )Tj 1 0 0 1 36.57001 93.81 Tm (person described the management as chaotic, saying that this has resulte\ d in people )Tj ET endstream endobj 759 0 obj 5070 endobj 760 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (not getting the care they need.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked to see if there are systems in place to ensure the home runs e\ fficiently and )Tj 1 0 0 1 34.32001 726.60999 Tm (safely, and that people get the care they need. We found that systems ar\ e not robust )Tj 1 0 0 1 34.32001 709.10999 Tm (enough to achieve this.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (For example we looked at the system for communicating peoples' needs and\ changing )Tj 1 0 0 1 34.32001 656.63 Tm (needs, and for ensuring that peoples' needs are met. The owners and mana\ ger told us )Tj 1 0 0 1 34.32001 639.13 Tm (that this is achieved through the care planning system. However, we foun\ d that these )Tj 1 0 0 1 34.32001 621.63 Tm (documents are complex and contradictory in places. They do not always pr\ ovide the )Tj 1 0 0 1 34.32001 604.14001 Tm (level of detail needed by staff to ensure that they have the information\ they need, and )Tj 1 0 0 1 34.32001 586.64001 Tm (to ensure that people's needs are met in a way that is consistent and of\ a satisfactory )Tj 1 0 0 1 34.32001 569.14996 Tm (quality. We found that reviews of people's care do not include all the i\ nformation )Tj 1 0 0 1 34.32001 551.64996 Tm (available and do not always provide evidence for some of the care decisi\ ons made )Tj 1 0 0 1 34.32001 534.14996 Tm (\(see Health and Personal Care\). Care staff told us they do not read ca\ re plans. We )Tj 1 0 0 1 34.32001 516.65997 Tm (asked if they got a hand over of information at the beginning of each sh\ ift and they )Tj 1 0 0 1 34.32001 499.16 Tm (told us they do not. We asked the manager how information is relayed to \ staff. She )Tj 1 0 0 1 34.32001 481.66998 Tm (told us that she expects the nurses to do this. The evidence in the Heal\ th and Personal )Tj 1 0 0 1 34.32001 464.16998 Tm (Care section of this report, shows that this is not happening.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked closely at how some decisions about people's care are made. Fo\ r example, )Tj 1 0 0 1 34.32001 411.67999 Tm (one record states that one person cannot make a decision about having be\ d rails on )Tj 1 0 0 1 34.32001 394.19 Tm (their bed. However, records show that this person has made a decision ab\ out having )Tj 1 0 0 1 34.32001 376.69 Tm (repeated invasive procedures. Another person can make the decision to ge\ t up at 6am )Tj 1 0 0 1 34.32001 359.19 Tm (but cannot make a decision about what they eat.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at how risks in the home are managed. We found that people are\ identified )Tj 1 0 0 1 34.32001 306.70999 Tm (as being at risk of falling. Care records instruct staff to observe them\ . Records show )Tj 1 0 0 1 34.32001 289.20999 Tm (that a lot of falls have happened to people when staff are not present. \ Although there )Tj 1 0 0 1 34.32001 271.70999 Tm (is a system for recording this information, there is not a system for mo\ nitoring and )Tj 1 0 0 1 34.32001 254.22 Tm (analysing this information, and therefore actions have not been taken to\ help prevent )Tj 1 0 0 1 34.32001 236.72 Tm (and reduce the number of falls.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (We looked to see if there is a safe system in place for moving and handl\ ing people )Tj 1 0 0 1 34.32001 184.23 Tm (with mobility problems. We found that assessments have not been carried \ out or had )Tj 1 0 0 1 34.32001 166.73999 Tm (been carried out a long time ago and have not been reviewed. We found th\ at decisions )Tj 1 0 0 1 34.32001 149.23999 Tm (about the type of equipment to be used are based on the equipment that i\ s available )Tj 1 0 0 1 34.32001 131.75 Tm (and not on what would be the most suitable for each person. The manager \ reports )Tj 1 0 0 1 34.32001 114.25 Tm (that staff have not had training in how to carry out moving and handling\ assessments.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 761 0 obj 5058 endobj 762 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We looked at how other risks in the home have been managed. We found tha\ t the )Tj 1 0 0 1 34.32001 761.60004 Tm (temperature of hot water is restricted to help ensure that people are no\ t scalded. We )Tj 1 0 0 1 34.32001 744.10999 Tm (found that windows have restricted openings to prevent people falling. H\ owever, we )Tj 1 0 0 1 34.32001 726.60999 Tm (found one window, that had been replaced that day, did not have a restri\ cted opening. )Tj 1 0 0 1 34.32001 709.10999 Tm (We told one of the owners who told us they thought that it had been rest\ ricted since )Tj 1 0 0 1 34.32001 691.62 Tm (we last looked. When we looked again, it had not.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked in the kitchen and found it clean and tidy. The owners identif\ ied )Tj 1 0 0 1 34.32001 639.13 Tm (approximately 4 years ago that the kitchen is coming to the end of its u\ seful life, and )Tj 1 0 0 1 34.32001 621.63 Tm (the Environmental Health Officer also identified this. The cook reports \ that a )Tj 1 0 0 1 34.32001 604.14001 Tm (refurbishment date has not yet been set.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We looked at how equipment is maintained. We found that the weighing sca\ les had )Tj 1 0 0 1 34.32001 551.64996 Tm (been weighing inaccurately for some time meaning that people at risk of \ malnutrition )Tj 1 0 0 1 34.32001 534.14996 Tm (could not be weighed accurately. The lift broke down for at least 2 days\ in October.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We looked at how the home involve people in the running of the home and \ how the )Tj 1 0 0 1 34.32001 481.66998 Tm (management team get feedback from people and improve the quality of care\ given. )Tj 1 0 0 1 34.32001 464.16998 Tm (We were told by relatives that meetings are sometimes held to which they\ are invited. )Tj 1 0 0 1 34.32001 446.66998 Tm (One person told us at that at the last meeting they had been informed th\ ere were )Tj 1 0 0 1 34.32001 429.17999 Tm (going to be a lot of changes in the home. They asked for, and the manage\ ment team )Tj 1 0 0 1 34.32001 411.67999 Tm (agreed they could have, a list of these changes so that they could prepa\ re their parent )Tj 1 0 0 1 34.32001 394.19 Tm (for these changes. They have not received this.)Tj 1 0 0 1 34.32001 376.69 Tm (\240)Tj 1 0 0 1 34.32001 359.19 Tm (We looked at the results of the most recent quality assurance survey \(J\ une 2009\). )Tj 1 0 0 1 34.32001 341.70001 Tm (Some people had said they were not satisfied with the length of time it \ took to answer )Tj 1 0 0 1 34.32001 324.20001 Tm (call bells. One person said that new staff were not given enough trainin\ g meaning that )Tj 1 0 0 1 34.32001 306.70999 Tm (they had to take instruction from the person they were meant to be carin\ g for. Two )Tj 1 0 0 1 34.32001 289.20999 Tm (people thought that improvements should be made to laundry and one to ir\ oning. We )Tj 1 0 0 1 34.32001 271.70999 Tm (asked how these issues had been addressed and the owner did not know bec\ ause the )Tj 1 0 0 1 34.32001 254.22 Tm (survey was carried out when the previous manager was employed.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We checked to see if previous requirements set by the commission have be\ en met. )Tj 1 0 0 1 34.32001 201.73 Tm (We found that requirements relating to health and welfare, care planning\ , )Tj 1 0 0 1 34.32001 184.23 Tm (safeguarding people, meeting people's social needs, staff skills and imp\ roving the )Tj 1 0 0 1 34.32001 166.73999 Tm (overall management have not been met.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We did not check any personal allowance accounts of the people living he\ re as the )Tj 1 0 0 1 34.32001 114.25 Tm (home does not hold any money on behalf of people. Instead they run a deb\ it account, )Tj 1 0 0 1 34.32001 96.75 Tm (recording all monies spent on people's behalf. Records and receipts are \ given to )Tj ET endstream endobj 763 0 obj 1648 endobj 764 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (35)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 126.35001 w 34.60001 748.22998 m 562.53998 748.22998 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 104.98 w 33.47 736.41998 m 563.65997 736.41998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 681.72998 l S 564.78998 791.10999 m 564.78998 681.72998 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 682.81 m 565.87 682.81 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (relatives and supporters for them to check and to pay for retrospectivel\ y.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (During our inspection it came to light that the commission are not being\ notified of all )Tj 1 0 0 1 34.32001 726.60999 Tm (incidents that affect the welfare of people living here as they should b\ e. 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They )Tj 1 0 0 1 294.54999 448.95999 Tm (must record their findings )Tj 1 0 0 1 294.54999 434.38 Tm (and send these to the )Tj 1 0 0 1 294.54999 419.80002 Tm (commission after each visit.)Tj 1 0 0 1 294.54999 405.22 Tm (\240)Tj 1 0 0 1 294.54999 390.63998 Tm (Previous timescale of )Tj 1 0 0 1 294.54999 376.06 Tm (13/04/07 not met.)Tj 1 0 0 1 294.54999 361.47998 Tm (\240)Tj 1 0 0 1 294.54999 346.89999 Tm (Not inspected on this )Tj 1 0 0 1 294.54999 332.32001 Tm (occasion. 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This )Tj 1 0 0 1 298.04999 446.73999 Tm (assessment must include )Tj 1 0 0 1 298.04999 429.73999 Tm (health and social care )Tj 1 0 0 1 298.04999 412.73999 Tm (assessments if the )Tj 1 0 0 1 298.04999 395.73999 Tm (placement takes place )Tj 1 0 0 1 298.04999 378.73999 Tm (through health or social care )Tj 1 0 0 1 298.04999 361.73999 Tm (services. )Tj 1 0 0 1 298.04999 344.73999 Tm (\240)Tj 1 0 0 1 298.04999 327.73999 Tm (This will help to ensure that )Tj 1 0 0 1 298.04999 310.73999 Tm (each person's needs are )Tj 1 0 0 1 298.04999 293.73999 Tm (identified and can be met. )Tj 1 0 0 1 482.10001 514.73999 Tm (07/12/2009)Tj 1 0 0 1 554.04999 514.73999 Tm (\240)Tj 1 0 0 1 35.5 274.48999 Tm (2)Tj 1 0 0 1 99.3 274.48999 Tm (7)Tj 1 0 0 1 201.55 274.48999 Tm (15)Tj 1 0 0 1 298.04999 274.48999 Tm (You must ensure that care )Tj 1 0 0 1 298.04999 257.48999 Tm (plans provide clear and up )Tj 1 0 0 1 298.04999 240.48999 Tm (to date instructions on how )Tj 1 0 0 1 298.04999 223.48999 Tm (each person's care needs )Tj 1 0 0 1 298.04999 206.48999 Tm (are to be met, recorded and )Tj 1 0 0 1 298.04999 189.48999 Tm (monitored. 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239.06998 Tm (4)Tj 1 0 0 1 96.15001 239.06998 Tm (30)Tj 1 0 0 1 202.5 239.06998 Tm (You must ensure that staff have had the training they need )Tj 1 0 0 1 202.5 224.48999 Tm (to care for people appropriately.)Tj ET endstream endobj 785 0 obj 1872 endobj 786 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (46)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 22.5 w 22.95 802.40997 m 560.45001 802.40997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 28.35001 799.08997 Tm (Helpline:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 28.35001 781.10999 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 28.35001 759.60004 Tm (Telephone:)Tj 0 Tr 1 0 0 1 95.88 759.60004 Tm ( 03000 616161)Tj 2 Tr 1 0 0 1 28.35001 739.60004 Tm (Email:)Tj 0 Tr 1 0 0 1 66.84 739.60004 Tm ( enquiries@cqc.org.uk)Tj 2 Tr 1 0 0 1 28.35001 719.60999 Tm (Web:)Tj 0 Tr 1 0 0 1 64.35001 719.60999 Tm (www.cqc.org.uk)Tj 1 0 0 1 28.35001 699.60999 Tm (\240)Tj 1 0 0 1 28.35001 679.60999 Tm (We want people to be able to access this information. If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 787 0 obj 4539 endobj 788 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 73.32001 w 31.2 470.10999 m 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for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. 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Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 793 0 obj 9115 endobj 794 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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281.29001 m 534.54999 281.29001 l S 536.79999 281.29001 m 565.90002 281.29001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 292.70001 m 568.10004 292.70001 l S 28.99001 269.87 m 568.10004 269.87 l S 30.07001 293.78 m 30.07001 268.80002 l S 316.37 293.78 m 316.37 268.80002 l S 347.66998 293.78 m 347.66998 268.80002 l S 379.01999 293.78 m 379.01999 268.80002 l S 410.31998 293.78 m 410.31998 268.80002 l S 441.66998 293.78 m 441.66998 268.80002 l S 473.01999 293.78 m 473.01999 268.80002 l S 504.31998 293.78 m 504.31998 268.80002 l S 535.66998 293.78 m 535.66998 268.80002 l S 567.01996 293.78 m 567.01996 268.80002 l S BT /T1_0 12 Tf 1 0 0 1 34.05 276.51999 Tm (Date of last inspection)Tj 1 0 0 1 328.20001 276.51999 Tm (0)Tj 1 0 0 1 359.53 276.51999 Tm (4)Tj 1 0 0 1 390.85999 276.51999 Tm (1)Tj 1 0 0 1 422.17999 276.51999 Tm (1)Tj 1 0 0 1 453.53 276.51999 Tm (2)Tj 1 0 0 1 484.85999 276.51999 Tm (0)Tj 1 0 0 1 516.17999 276.51999 Tm (0)Tj 1 0 0 1 547.52997 276.51999 Tm (8)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 258 m 565.90002 258 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 248.37 m 568.10004 248.37 l S 30.07001 249.45 m 30.07001 39.14999 l S 567.01996 249.45 m 567.01996 39.14999 l S 28.99001 267.62 m 568.10004 267.62 l S 28.99001 248.37 m 568.10004 248.37 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 268.70001 m 30.07001 247.28998 l S 567.01996 268.70001 m 567.01996 247.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 254.43999 Tm (Brief description of the )Tj 1 0 0 1 177.31 254.43999 Tm (care home)Tj 1 0 0 1 35.5 235.18999 Tm (Honiton Manor is registered to provide 24 hour nursing care for up to 22\ service users )Tj 1 0 0 1 35.5 218.19 Tm (who have needs relating to 'older people'.)Tj 1 0 0 1 35.5 201.19 Tm (\240)Tj 1 0 0 1 35.5 184.19 Tm (The two-storey home is an older style building situated on the main road\ into, and )Tj 1 0 0 1 35.5 167.19 Tm (quite close to, Honiton and the local amenities. It is on public transpo\ rt routes.)Tj 1 0 0 1 35.5 150.19 Tm (\240)Tj 1 0 0 1 35.5 133.19 Tm (There are eleven single bedrooms and five double bedrooms situated on th\ e ground )Tj 1 0 0 1 35.5 116.19 Tm (and first floors. One of the double bedrooms has an ensuite bathroom. A \ passenger lift )Tj 1 0 0 1 35.5 99.19 Tm (and a staircase link the floors.)Tj 1 0 0 1 35.5 82.19 Tm (\240)Tj 1 0 0 1 35.5 65.19 Tm (Communal space is made up of a large lounge and a dining room, both on t\ he ground )Tj 1 0 0 1 35.5 48.19 Tm (floor.)Tj ET endstream endobj 795 0 obj 1404 endobj 796 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 689.07996 l S 567.01996 795.47998 m 567.01996 689.07996 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 690.14996 m 568.10004 690.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (\240)Tj 1 0 0 1 33.25 766.46997 Tm (Outside there is access to a seating area and parking.)Tj 1 0 0 1 33.25 749.46997 Tm (\240)Tj 1 0 0 1 33.25 732.46997 Tm (Current charges are \243515.00 - \243675.00 per week. Charges do not inc\ lude items such )Tj 1 0 0 1 33.25 715.46997 Tm (as newspapers, toiletries, taxis etc.)Tj 1 0 0 1 33.25 698.46997 Tm (\240)Tj ET endstream endobj 797 0 obj 3597 endobj 798 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (This unannounced key inspection was due to be undertaken in November 200\ 9. It was )Tj 1 0 0 1 35.17 240.90001 Tm (bought forward as we had received some concerns about the quality of car\ e that )Tj 1 0 0 1 35.17 226.31998 Tm (people living here are receiving.)Tj 1 0 0 1 35.17 211.73999 Tm (\240)Tj 1 0 0 1 35.17 197.14998 Tm (During this visit we \(the commission\) spoke with or observed the major\ ity of people )Tj 1 0 0 1 35.17 182.56999 Tm (living here. We could not speak with some people because they have commu\ nication )Tj 1 0 0 1 35.17 167.98999 Tm (difficulties such as dementia. We looked closely at the care, services a\ nd )Tj 1 0 0 1 35.17 153.41 Tm (accommodation offered to four people living here. This is called case tr\ acking and helps )Tj 1 0 0 1 35.17 138.84 Tm (us to make a judgment about the standard of care overall, and helps us t\ o understand )Tj 1 0 0 1 35.17 124.25 Tm (the experiences of people who live here.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (We looked at the care and attention given by staff to these people and w\ e looked at )Tj 1 0 0 1 35.17 80.50999 Tm (their assessments and at their care planning records. We looked at the e\ nvironment in )Tj 1 0 0 1 35.17 65.93001 Tm (relation to their needs and how their health and personal care needs are\ met. We also )Tj ET endstream endobj 799 0 obj 2315 endobj 800 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 280.01999 w 32.32001 672.51996 m 566.71997 672.51996 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 531.38 m 568.91998 531.38 l S 31.2 814.72998 m 31.2 530.31 l S 567.84998 814.72998 m 567.84998 530.31 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (spoke with visitors to the home, with staff and with the manager and one\ of the )Tj 1 0 0 1 32.92 788.13995 Tm (owners. We visited the majority of bedrooms and saw all service and comm\ unal areas )Tj 1 0 0 1 32.92 773.56 Tm (of the home.)Tj 1 0 0 1 32.92 758.97998 Tm (\240)Tj 1 0 0 1 32.92 744.40002 Tm (We looked at records relating to accidents and incidents, staff training\ , staff )Tj 1 0 0 1 32.92 729.82001 Tm (recruitment, medication and at some policies.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (Prior to the inspection the owners sent us their Annual Quality Assuranc\ e Assessment )Tj 1 0 0 1 32.92 686.07996 Tm (\(AQAA\) which gave us information about the home and it's management an\ d about the )Tj 1 0 0 1 32.92 671.5 Tm (needs of people living here. This document asks for evidence in relation\ to what the )Tj 1 0 0 1 32.92 656.91998 Tm (home does well and what they think they can improve upon.)Tj 1 0 0 1 32.92 642.33997 Tm (\240)Tj 1 0 0 1 32.92 627.76001 Tm (In addition, we sent surveys to 8 people living here and 3 were returned\ . We sent 8 )Tj 1 0 0 1 32.92 613.17999 Tm (surveys to staff and 3 were returned. We sent 4 surveys to health and so\ cial care )Tj 1 0 0 1 32.92 598.60004 Tm (professionals and all were returned. Feedback and comments are included \ in the )Tj 1 0 0 1 32.92 584.01996 Tm (report.)Tj 1 0 0 1 32.92 569.44 Tm (\240)Tj 1 0 0 1 32.92 554.85999 Tm (During this inspection evidence was taken under the Police and Criminal \ Evidence Act )Tj 1 0 0 1 32.92 540.27997 Tm (and this has been considered under our enforcement procedures.)Tj ET endstream endobj 801 0 obj 6453 endobj 802 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 64.32001 w 32.32001 741.65997 m 566.71997 741.65997 l S 20.58 w 32.7 696.95996 m 569.34998 696.95996 l S 93.48 w 33.82001 637.67999 m 568.21997 637.67999 l S 20.58 w 33.45 578.40002 m 570.10004 578.40002 l S 501.84 w 34.57001 314.94998 m 568.96997 314.94998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 708.38 m 568.91998 708.38 l S 31.2 776.02997 m 31.2 707.29999 l S 31.2 708.38 m 569.34998 708.38 l S 32.7 685.54999 m 569.34998 685.54999 l S 31.62 685.54999 m 570.41998 685.54999 l S 31.62 589.82001 m 570.41998 589.82001 l S 33.45 566.98999 m 570.10004 566.98999 l S 33.45 589.82001 m 570.10004 589.82001 l S 32.37 566.98999 m 571.16998 566.98999 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 686.63 m 32.7 588.73999 l S 33.45 568.07001 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 707.29999 l S 569.34998 686.63 m 569.34998 588.73999 l S 570.10004 568.07001 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (This home is warm, clean and comfortable. Staff are described as nice an\ d caring and )Tj 1 0 0 1 35.17 744.17999 Tm (as doing their best. The home has a lot of nursing equipment such as adj\ ustable beds )Tj 1 0 0 1 35.17 729.60004 Tm (and pressure relieving mattresses. People really enjoy the food served h\ ere which is )Tj 1 0 0 1 35.17 715.01996 Tm (nutritious and offers variety. )Tj /T1_0 10 Tf 1 0 0 1 568.96997 740.10999 Tm (\240)Tj 1 0 0 1 31.2 694.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 692.19 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 695.40997 Tm (\240)Tj 1 0 0 1 31.2 636.13 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 669.35999 Tm (Since the last inspection the programme of redecoration has continued. W\ e saw that a )Tj 1 0 0 1 36.67 654.77997 Tm (window was being replaced and that the front door is now secured with a \ key pad type )Tj 1 0 0 1 36.67 640.20001 Tm (lock.)Tj 1 0 0 1 36.67 625.62 Tm (The home has employed a part time activities co-ordinator and this perso\ n's efforts are )Tj 1 0 0 1 36.67 611.03998 Tm (having an impact for some people.)Tj 1 0 0 1 36.67 596.45996 Tm (The Requirement made at the last inspection in relation to medicines has\ been met. )Tj /T1_0 10 Tf 1 0 0 1 570.46997 636.13 Tm (\240)Tj 1 0 0 1 31.2 576.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 573.63 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 313.38998 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 550.79999 Tm (This home does not have a registered manager and is not being sufficient\ ly well )Tj 1 0 0 1 37.42 536.21997 Tm (managed. This has resulted in people's health and welfare needs not alwa\ ys being )Tj 1 0 0 1 37.42 521.64001 Tm (assessed or met. The care planning and communicating systems in place ar\ e not )Tj 1 0 0 1 37.42 507.06 Tm (sufficiently robust to ensure that care staff have the information they \ need about )Tj 1 0 0 1 37.42 492.47998 Tm (people's care needs and how these should be met.)Tj 1 0 0 1 37.42 477.89993 Tm (\240)Tj 1 0 0 1 37.42 463.31998 Tm (Staff are well intentioned but are not always on duty in sufficient numb\ ers, and do not )Tj 1 0 0 1 37.42 448.73999 Tm (always have the support they need, to meet people's needs. On one night \ there was )Tj 1 0 0 1 37.42 434.16 Tm (not a waking Registered Nurse on duty. Staff are not recruited in a robu\ st way and this )Tj 1 0 0 1 37.42 419.57999 Tm (means that people are at risk of being cared for by inappropriate staff.\ )Tj 1 0 0 1 37.42 405 Tm (\240)Tj 1 0 0 1 37.42 390.41998 Tm (People are not always treated with dignity and their rights to make choi\ ces or to be )Tj 1 0 0 1 37.42 375.84 Tm (engaged and sociable are not always supported. Some people's sense of se\ lf and )Tj 1 0 0 1 37.42 361.25998 Tm (personal identity is in danger of being eroded by a system that is not a\ lways person )Tj 1 0 0 1 37.42 346.67999 Tm (centred and is sometimes institutionalised.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Complaints have been made to the commission by some people. They complai\ n that )Tj 1 0 0 1 37.42 302.94 Tm (the home is not well managed and the quality of care has declined. These\ concerns are )Tj 1 0 0 1 37.42 288.35999 Tm (being investigated by the local safeguarding team. This is the second sa\ feguarding )Tj 1 0 0 1 37.42 273.78 Tm (alert that has been made since the last inspection. Whilst this investig\ ation is ongoing, )Tj 1 0 0 1 37.42 259.20001 Tm (admissions to this home via health or social care services have been sus\ pended by )Tj 1 0 0 1 37.42 244.62 Tm (Adult and Community Services.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Staff training is not up to date and some specialist training is being d\ esignated to )Tj 1 0 0 1 37.42 200.87999 Tm (people who are not qualified or experienced to carry this out.)Tj 1 0 0 1 37.42 186.3 Tm (\240)Tj 1 0 0 1 37.42 171.72 Tm (Some working practices and systems are not ensuring people's safety. Thi\ s includes )Tj 1 0 0 1 37.42 157.14 Tm (moving and handling people, ensuring windows are restricted to prevent a\ ccidental )Tj 1 0 0 1 37.42 142.56 Tm (falls, the maintenance of equipment and risk assessments and actions in \ relation to the )Tj 1 0 0 1 37.42 127.98 Tm (use of restraint. Systems are not robust enough to ensure that it is cle\ ar which staff )Tj 1 0 0 1 37.42 113.40001 Tm (have received mandatory training and which have not. The system for reco\ rding and )Tj 1 0 0 1 37.42 98.82001 Tm (monitoring accidents and incidents is not being used to help prevent fur\ ther accidents.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (The commission have not been kept informed in relation to all incidents,\ accidents and )Tj ET endstream endobj 803 0 obj 2243 endobj 804 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 148.8 w 34.57001 738.13 m 568.96997 738.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 662.60004 m 571.16998 662.60004 l S 33.45 814.72998 m 33.45 661.52997 l S 570.10004 814.72998 m 570.10004 661.52997 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (deaths in the home, as we should be so that we can monitor this type of \ activity in the )Tj 1 0 0 1 35.17 788.13995 Tm (home.)Tj 1 0 0 1 35.17 773.56 Tm (\240)Tj 1 0 0 1 35.17 758.97998 Tm (Statutory Requirement Notices have been issued to the registered owners \ of this )Tj 1 0 0 1 35.17 744.40002 Tm (service. These Notices inform the providers that they have failed to com\ ply with the )Tj 1 0 0 1 35.17 729.82001 Tm (Care Home Regulations 2001 in relation to planning people's care and in \ relation to )Tj 1 0 0 1 35.17 715.23999 Tm (meeting people's health and welfare needs. The Statutory Requirement Not\ ices tell the )Tj 1 0 0 1 35.17 700.65997 Tm (providers what they must do and gives them dates by when the failures id\ entified must )Tj 1 0 0 1 35.17 686.07996 Tm (be addressed.)Tj 1 0 0 1 35.17 671.5 Tm (\240)Tj 1 0 0 1 28.35001 648.03998 Tm (\240)Tj 1 0 0 1 28.35001 628.04999 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 628.04999 Tm (care home)Tj 1 0 0 1 480.03998 628.04999 Tm ( is taking )Tj 1 0 0 1 28.35001 610.54999 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 590.56 Tm (\240)Tj 1 0 0 1 28.35001 570.56 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 570.56 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 550.56 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 550.56 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 530.57001 Tm (order line 0870 240 7535.)Tj ET endstream endobj 805 0 obj 1804 endobj 806 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 807 0 obj 5905 endobj 808 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (Some people move into this home without having their needs fully assesse\ d and )Tj 1 0 0 1 36.62 341.25 Tm (without agreement from the funding authority. This means that people can\ not be sure )Tj 1 0 0 1 36.62 323.75998 Tm (that their needs will be met in an appropriate way or that they will be \ staying in this )Tj 1 0 0 1 36.62 306.25998 Tm (home. )Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (In surveys two out of three people who live here told us that they had t\ he information )Tj 1 0 0 1 36.57001 216.78 Tm (they needed to decide if this was the home for them. In addition, two ou\ t of three )Tj 1 0 0 1 36.57001 199.28 Tm (health care professionals say that the home's assessment arrangements us\ ually )Tj 1 0 0 1 36.57001 181.78998 Tm (ensure that accurate information is gathered and that the right service \ is planned for )Tj 1 0 0 1 36.57001 164.28999 Tm (people. One health care professional told us that this always happens.)Tj 1 0 0 1 36.57001 146.78999 Tm (\240)Tj 1 0 0 1 36.57001 129.3 Tm (We were told that the home had admitted two people to this home without \ an )Tj 1 0 0 1 36.57001 111.8 Tm (assessment by and without the agreement of the funding authority. When w\ e looked )Tj 1 0 0 1 36.57001 94.31 Tm (at records we found these people had been admitted from a residential ho\ me owned )Tj ET endstream endobj 809 0 obj 2644 endobj 810 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 336.30002 w 34.60001 643.26001 m 562.53998 643.26001 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 314.92999 w 33.47 631.44 m 563.65997 631.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 471.78 l S 564.78998 791.10999 m 564.78998 471.78 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 472.85999 m 565.87 472.85999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (by the owners of this home.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We spoke with staff who told us that one of these people had moved here \ because )Tj 1 0 0 1 34.32001 726.60999 Tm (they have nursing needs and therefore need their care to be planned and \ delivered by )Tj 1 0 0 1 34.32001 709.10999 Tm (registered nurses.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We looked at the records of one of these people. We found that an assess\ ment of their )Tj 1 0 0 1 34.32001 656.63 Tm (nursing needs had not taken place prior to their admission, or since the\ ir admission. )Tj 1 0 0 1 34.32001 639.13 Tm (We found that all assessments in their records have been carried out in \ the home they )Tj 1 0 0 1 34.32001 621.63 Tm (used to live in.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (We could not speak with this person about their feelings about the move \ as they have )Tj 1 0 0 1 34.32001 569.14996 Tm (communication difficulties. We spoke with the relative of another person\ living here. )Tj 1 0 0 1 34.32001 551.64996 Tm (They told us that they had looked around the home and at the bedroom the\ person )Tj 1 0 0 1 34.32001 534.14996 Tm (would move into. They were able to ask questions about the home before d\ eciding this )Tj 1 0 0 1 34.32001 516.65997 Tm (was the right home. However, we noted that this person's care record did\ not contain )Tj 1 0 0 1 34.32001 499.16 Tm (pre admission information from health and social care professionals as i\ t should.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj ET endstream endobj 811 0 obj 5782 endobj 812 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 403.25 m 562.53998 403.25 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 119.35001 w 33.47 392 m 563.65997 392 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 330.12 l S 564.78998 453.88 m 564.78998 330.12 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 331.20001 m 565.87 331.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (Peoples' medicines are safely managed. However, some people are being pu\ t at risk )Tj 1 0 0 1 36.62 375.25 Tm (because their health and welfare needs are not being met. People do not \ have their )Tj 1 0 0 1 36.62 357.75998 Tm (care planned in a person centred way that treats them as individuals and\ are not )Tj 1 0 0 1 36.62 340.25998 Tm (always treated with dignity. )Tj 1 0 0 1 28.35001 315.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.3 w 34.60001 193.67999 m 562.53998 193.67999 l S 1 1 1 RG 22.5 w 32.35001 296.32999 m 564.78998 296.32999 l S 201.92998 w 33.47 181.87 m 563.65997 181.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 283.95999 m 565.87 283.95999 l S 32.35001 285.04001 m 32.35001 78.70001 l S 564.78998 285.04001 m 564.78998 78.70001 l S 32.35001 283.95999 m 564.78998 283.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.26999 Tm (In surveys people living here told us they usually get the care and supp\ ort they need )Tj 1 0 0 1 36.57001 250.78 Tm (and that they always or usually get the medical support they need.)Tj 1 0 0 1 36.57001 233.28 Tm (\240)Tj 1 0 0 1 36.57001 215.78998 Tm (Two health care professionals told us that people's health care needs ar\ e always )Tj 1 0 0 1 36.57001 198.28998 Tm (properly monitored and one told us this usually happens. Two also said t\ hat the staff )Tj 1 0 0 1 36.57001 180.78998 Tm (at the home seek advice and act on it to improve well being, and one sai\ d that this )Tj 1 0 0 1 36.57001 163.3 Tm (sometimes happened. Comments from health care professionals include that\ staff act )Tj 1 0 0 1 36.57001 145.8 Tm (promptly to get medical help for people who need it and that some people\ have )Tj 1 0 0 1 36.57001 128.31 Tm (blossomed since living here.)Tj 1 0 0 1 36.57001 110.81 Tm (\240)Tj 1 0 0 1 36.57001 93.31 Tm (We looked in depth at the care plans of four people living here. We also\ looked at )Tj ET endstream endobj 813 0 obj 5378 endobj 814 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (some others. We found that each person has a plan of care and that these\ contain a )Tj 1 0 0 1 34.32001 761.60004 Tm (large number and range of documents relating to care needs. However, the\ se )Tj 1 0 0 1 34.32001 744.10999 Tm (documents were not person centred, are sometimes contradictory and do no\ t always )Tj 1 0 0 1 34.32001 726.60999 Tm (provide care staff with the detailed information that they need to meet \ people's needs.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (For example one person that we case tracked has been admitted from the o\ wners' )Tj 1 0 0 1 34.32001 674.12 Tm (residential home. This person's care plan is the care plan from that hom\ e. Staff told us )Tj 1 0 0 1 34.32001 656.63 Tm (that the reason this person was admitted to this home was because staff \ believe that )Tj 1 0 0 1 34.32001 639.13 Tm (they need the 24 hour care of nurses. However, nurses have not devised a\ care plan )Tj 1 0 0 1 34.32001 621.63 Tm (as to how this person's nursing needs are to be met. In addition, inform\ ation recorded )Tj 1 0 0 1 34.32001 604.14001 Tm (in the daily notes from the residential home has not been followed up. B\ efore being )Tj 1 0 0 1 34.32001 586.64001 Tm (admitted to this home, it was recorded that this person has a urinary ca\ theter, is )Tj 1 0 0 1 34.32001 569.14996 Tm (prone to urinary tract infections and needs encouragement to drink. Two \ days before )Tj 1 0 0 1 34.32001 551.64996 Tm (being admitted it is recorded that this person had very strong and dark \ urine which )Tj 1 0 0 1 34.32001 534.14996 Tm (means this person may not be drinking enough fluid. This person has live\ d in this care )Tj 1 0 0 1 34.32001 516.65997 Tm (home for approximately 6 weeks and the care notes have not mentioned thi\ s person's )Tj 1 0 0 1 34.32001 499.16 Tm (urine. We asked staff about this and they told us that the night staff e\ mpty the )Tj 1 0 0 1 34.32001 481.66998 Tm (catheter bag and that they didn't know how much urine this person passed\ or what )Tj 1 0 0 1 34.32001 464.16998 Tm (colour it is.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked to see how much this person drinks in a day because the reside\ ntial care )Tj 1 0 0 1 34.32001 411.67999 Tm (home instructions state that they should be encouraged to drink to preve\ nt urinary )Tj 1 0 0 1 34.32001 394.19 Tm (tract infections. We saw records that show this person drinks between 20\ 0mls and )Tj 1 0 0 1 34.32001 376.69 Tm (1050mls in a day. The records do not contain instructions about how much\ this person )Tj 1 0 0 1 34.32001 359.19 Tm (should drink in a day. We asked carers how much this person should drink\ to keep )Tj 1 0 0 1 34.32001 341.70001 Tm (them healthy and they thought that this would be about 1000mls. We asked\ carers if )Tj 1 0 0 1 34.32001 324.20001 Tm (they knew how much this person had drunk in the past days and they said \ they did )Tj 1 0 0 1 34.32001 306.70999 Tm (not because the nurse totals up the amount drunk. A nurse has reviewed t\ he records )Tj 1 0 0 1 34.32001 289.20999 Tm (kept about this person and the amount they have drunk. They record, in d\ ifferent )Tj 1 0 0 1 34.32001 271.70999 Tm (places in the care plan, that they have drunk a fair amount, small amoun\ t and a good )Tj 1 0 0 1 34.32001 254.22 Tm (amount. However, these reviews do not appear to have taken into account \ the days )Tj 1 0 0 1 34.32001 236.72 Tm (when this person has only drunk 200mls, 350mls and 400mls. We have calcu\ lated )Tj 1 0 0 1 34.32001 219.23 Tm (that this person, according to their weight, should have at least 1880ml\ s to drink each )Tj 1 0 0 1 34.32001 201.73 Tm (day. We spoke with the temporary manager about how much people should dr\ ink. She )Tj 1 0 0 1 34.32001 184.23 Tm (told us she knows there is a calculation to work this out, but does not \ know what it is. )Tj 1 0 0 1 34.32001 166.73999 Tm (We also noted that records show that this person does not have a drink b\ etween 6pm )Tj 1 0 0 1 34.32001 149.23999 Tm (and 8 or 9am. This is a very long time for someone who has a catheter an\ d is prone to )Tj 1 0 0 1 34.32001 131.75 Tm (urinary tract infections.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (We observed this person on the day of this inspection. They had numerous\ drinks put )Tj ET endstream endobj 815 0 obj 5195 endobj 816 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (in front of them by members of staff. No encouragement to drink was give\ n by staff, )Tj 1 0 0 1 34.32001 761.60004 Tm (but was given by their wife. we would estimate that this person drank ap\ proximately )Tj 1 0 0 1 34.32001 744.10999 Tm (50mls between 10am and 1pm.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We also saw that other people do not have enough to drink.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We saw in care plans that people are assessed to see if they are at risk\ of developing )Tj 1 0 0 1 34.32001 656.63 Tm (pressure sores. We saw that people we had case tracked are at risk. Thes\ e people are )Tj 1 0 0 1 34.32001 639.13 Tm (cared for on pressure relieving mattresses and cushions as is good pract\ ice. Some )Tj 1 0 0 1 34.32001 621.63 Tm (people are also nursed on adjustable beds which is also good practice. W\ e were told )Tj 1 0 0 1 34.32001 604.14001 Tm (that one person has developed a pressure sore since coming to live here \ and that one )Tj 1 0 0 1 34.32001 586.64001 Tm (person came to the home having already developed a pressure sore. We loo\ ked at )Tj 1 0 0 1 34.32001 569.14996 Tm (some pressure relieving equipment. We found one mattress had been set to\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (maximum pressure indicating that the person using this mattress is heavy\ . When we )Tj 1 0 0 1 34.32001 534.14996 Tm (looked in care records we found that this person is very light. We asked\ staff how they )Tj 1 0 0 1 34.32001 516.65997 Tm (work out the pressure that the mattress should be set to. One person sai\ d they did )Tj 1 0 0 1 34.32001 499.16 Tm (not know, another said the person setting it up does it. We looked in ca\ re plans, in )Tj 1 0 0 1 34.32001 481.66998 Tm (people's bedrooms and on the mattress motors to see if staff have access\ to )Tj 1 0 0 1 34.32001 464.16998 Tm (instructions about the pressure each mattress should be set at. We did n\ ot find any )Tj 1 0 0 1 34.32001 446.66998 Tm (instructions.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We saw in care plans that some people are at risk of malnutrition. One p\ erson we case )Tj 1 0 0 1 34.32001 394.19 Tm (tracked is losing weight. The GP has been informed. However, the recomme\ ndations )Tj 1 0 0 1 34.32001 376.69 Tm (made by the specialist nutritional tool used \(MUST\) have not been foll\ owed. According )Tj 1 0 0 1 34.32001 359.19 Tm (to this person's level of risk they should be having specific drinks to \ supplement their )Tj 1 0 0 1 34.32001 341.70001 Tm (calorie intake. Records show that these are given intermittently and not\ routinely. We )Tj 1 0 0 1 34.32001 324.20001 Tm (asked staff if this person has supplement drinks and they said no.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We noted in another person's records that they had been having loose bow\ el motions )Tj 1 0 0 1 34.32001 271.70999 Tm (and saw and heard from a relative that they had been off their food. Rec\ ords also )Tj 1 0 0 1 34.32001 254.22 Tm (show that this person has been what is described as 'grumpy'. This perso\ n has been )Tj 1 0 0 1 34.32001 236.72 Tm (weighed weekly. Although the most recent weight shows a weight gain, the\ general )Tj 1 0 0 1 34.32001 219.23 Tm (trend is that this person is losing weight. There was no record to show \ that this is )Tj 1 0 0 1 34.32001 201.73 Tm (being addressed. Staff are not keeping records of what this person eats \ and drinks. A )Tj 1 0 0 1 34.32001 184.23 Tm (nurse had recorded that they had reviewed this care plan but had not tak\ en any action )Tj 1 0 0 1 34.32001 166.73999 Tm (to address these health issues. This means that this person's health is \ not being )Tj 1 0 0 1 34.32001 149.23999 Tm (monitored appropriately and might result in a delay in appropriate actio\ n being taken.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (Prior to this inspection, the owners provided us with an updated improve\ ment plan in )Tj 1 0 0 1 34.32001 96.75 Tm (relation to requirements made at the last inspection about meeting peopl\ e's nutritional )Tj ET endstream endobj 817 0 obj 5376 endobj 818 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs. This told us that the completion of the nutritional risk assessme\ nt tool \(MUST\) )Tj 1 0 0 1 34.32001 761.60004 Tm (and for taking action if risk is identified has been designated to the c\ atering manager. )Tj 1 0 0 1 34.32001 744.10999 Tm (This person, along with other staff in the home, has received training i\ n relation to )Tj 1 0 0 1 34.32001 726.60999 Tm (nutrition from a company that supplies nutritional supplements. However,\ this does )Tj 1 0 0 1 34.32001 709.10999 Tm (not qualify them to carry out these assessments or to determine the acti\ ons that )Tj 1 0 0 1 34.32001 691.62 Tm (should be taken.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (Another care plan recorded that one person stays in bed all day and does\ not get )Tj 1 0 0 1 34.32001 639.13 Tm (dressed. It states the reason for this as them being immobile and having\ contractures )Tj 1 0 0 1 34.32001 621.63 Tm (of their legs. Records do not include evidence that consideration has be\ en given, or )Tj 1 0 0 1 34.32001 604.14001 Tm (that actions have been taken, to make arrangements or find moving and ha\ ndling )Tj 1 0 0 1 34.32001 586.64001 Tm (equipment that might allow this person to move out of their bed.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We looked at other records relating to people with dementia. Care plans \ state for )Tj 1 0 0 1 34.32001 534.14996 Tm (example, that some people have a poor mental state and reduced powers of\ )Tj 1 0 0 1 34.32001 516.65997 Tm (comprehension. However, care plans do not provide a plan as to how these\ people's )Tj 1 0 0 1 34.32001 499.16 Tm (mental health and welfare needs are to be addressed or met. In addition,\ it has been )Tj 1 0 0 1 34.32001 481.66998 Tm (agreed on three people's behalf, who are described as confused or having\ dementia, )Tj 1 0 0 1 34.32001 464.16998 Tm (that they would like to get them up as early as 6am. One of these people\ has an )Tj 1 0 0 1 34.32001 446.66998 Tm (illness the symptoms of which include stiffness, especially in the morni\ ng and fatigue. )Tj 1 0 0 1 34.32001 429.17999 Tm (These symptoms do not seem to have been considered in the decision to ge\ t them up )Tj 1 0 0 1 34.32001 411.67999 Tm (early.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We observed that one person is at high risk of choking as they have diff\ iculty )Tj 1 0 0 1 34.32001 359.19 Tm (swallowing. This person was referred to the Speech and Language Therapis\ t \(SALT\) )Tj 1 0 0 1 34.32001 341.70001 Tm (some time ago. However, a visiting health care professional observed tha\ t staff were )Tj 1 0 0 1 34.32001 324.20001 Tm (not following the guidance given by the SALT. They asked this specialist\ to visit again. )Tj 1 0 0 1 34.32001 306.70999 Tm (Instructions were left for staff to follow as to how this person is to b\ e supported to )Tj 1 0 0 1 34.32001 289.20999 Tm (eat. We saw that some of this guidance is being put into practice. Howev\ er, we also )Tj 1 0 0 1 34.32001 271.70999 Tm (saw that some is not. For example, we saw that nurses saw a visitor offe\ ring this )Tj 1 0 0 1 34.32001 254.22 Tm (person a chocolate covered wafer. They did not explain to the visitor th\ at this might )Tj 1 0 0 1 34.32001 236.72 Tm (cause problems for this person's swallowing. We saw this person in their\ wheelchair, )Tj 1 0 0 1 34.32001 219.23 Tm (leaning over to one side after lunch. This person is meant to sit up for\ 30 mins after )Tj 1 0 0 1 34.32001 201.73 Tm (eating. We saw that a member of staff put this person to bed soon after \ lunch, lying )Tj 1 0 0 1 34.32001 184.23 Tm (down. We asked staff about how this person is supported to eat and not c\ hoke. They )Tj 1 0 0 1 34.32001 166.73999 Tm (told us what they knew, but did not know that this person should be sat \ up for 30mins )Tj 1 0 0 1 34.32001 149.23999 Tm (after they had eaten. Staff told us this person has a pureed diet which \ complies with )Tj 1 0 0 1 34.32001 131.75 Tm (the SALT instructions. They also told us that they give this person cake\ and biscuits, )Tj 1 0 0 1 34.32001 114.25 Tm (which puts this person at risk of choking. The care plan does not contai\ n instructions )Tj 1 0 0 1 34.32001 96.75 Tm (for staff about what to do if this person chokes. One carer told us they\ would use their )Tj ET endstream endobj 819 0 obj 5253 endobj 820 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (common sense and try a grab and thrust movement. A nurse told us she hop\ ed that )Tj 1 0 0 1 34.32001 761.60004 Tm (staff would know to call a nurse or 999. This lack of instruction means \ that there may )Tj 1 0 0 1 34.32001 744.10999 Tm (be a delay in this person getting appropriate help.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We asked the manager how staff have been given information about this pe\ rson's )Tj 1 0 0 1 34.32001 691.62 Tm (needs and risk of choking since the most recent visit by the SALT. We we\ re told that )Tj 1 0 0 1 34.32001 674.12 Tm (the nurses had been told about the special requirements for this person,\ and the )Tj 1 0 0 1 34.32001 656.63 Tm (nurses were named, and that they give this information to the carers. We\ saw from )Tj 1 0 0 1 34.32001 639.13 Tm (the duty rota that one of these nurses had been on sick leave over this \ period. The )Tj 1 0 0 1 34.32001 621.63 Tm (manager confirmed this adding that the nurses already knew about the adv\ ice. We )Tj 1 0 0 1 34.32001 604.14001 Tm (reminded her that the SALT referral was made again because staff were no\ t following )Tj 1 0 0 1 34.32001 586.64001 Tm (the advice given, and this was putting this person at risk of choking.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We saw in the improvement plan provided by the owners that staff have ha\ d training )Tj 1 0 0 1 34.32001 534.14996 Tm (from the SALT in supporting people who have difficulties swallowing. Thi\ s document )Tj 1 0 0 1 34.32001 516.65997 Tm (also tells us that further updates will be given by the catering manager\ . This person is )Tj 1 0 0 1 34.32001 499.16 Tm (not qualified to do this and this is not good practice. We have checked \ with the SALT )Tj 1 0 0 1 34.32001 481.66998 Tm (and they have told us that they are happy to provide further training if\ needed.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We saw that many people living here have mobility problems. We checked c\ are plans )Tj 1 0 0 1 34.32001 429.17999 Tm (to see if people had had their moving and handling needs assessed. We fo\ und that )Tj 1 0 0 1 34.32001 411.67999 Tm (some people had not had these needs assessed. We found another that was \ dated )Tj 1 0 0 1 34.32001 394.19 Tm (April 2007 which had not been reviewed or updated since that time. Care \ plans give )Tj 1 0 0 1 34.32001 376.69 Tm (very general instructions for care staff such as 'needs hoist'. They did\ not specify the )Tj 1 0 0 1 34.32001 359.19 Tm (type of hoist to be used or the size of sling. We spoke to a nurse about\ how staff know )Tj 1 0 0 1 34.32001 341.70001 Tm (which hoist and sling to use. The nurse told us that if a person is on t\ he ground floor )Tj 1 0 0 1 34.32001 324.20001 Tm (they use the hoist that is on that floor and that carers make a judgment\ about what )Tj 1 0 0 1 34.32001 306.70999 Tm (size sling to use. This means that carers are not being supported to ens\ ure that they )Tj 1 0 0 1 34.32001 289.20999 Tm (use the appropriate equipment for each person.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (We also noted that the hoist is often used to help people who have been \ incontinent of )Tj 1 0 0 1 34.32001 236.72 Tm (urine. We saw that people share slings which does not help to prevent th\ e spread of )Tj 1 0 0 1 34.32001 219.23 Tm (infection and indicates that care is de-personalised.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Care plans in this home are in two parts. There is a larger comprehensiv\ e part which )Tj 1 0 0 1 34.32001 166.73999 Tm (contains details relating to the person and the plan of care. There is a\ lso a day to day )Tj 1 0 0 1 34.32001 149.23999 Tm (record which the manager told us is what carers use. Instructions in the\ se smaller )Tj 1 0 0 1 34.32001 131.75 Tm (records contain task orientated information such as needs feeding, hoist\ , weekly )Tj 1 0 0 1 34.32001 114.25 Tm (weight and on fluid chart. These are not person centred and do not give \ care staff the )Tj 1 0 0 1 34.32001 96.75 Tm (information they need to provide individualised care based on each perso\ n's individual )Tj ET endstream endobj 821 0 obj 4999 endobj 822 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs and preferences.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (Carers told us they do not tend to read care plans, although they do wri\ te in them. For )Tj 1 0 0 1 34.32001 726.60999 Tm (example they record fluid and food intake if people need to have this re\ corded. We )Tj 1 0 0 1 34.32001 709.10999 Tm (found that entries made by staff include impersonal comments such as pad\ changed, )Tj 1 0 0 1 34.32001 691.62 Tm (repositioned, soaking wet bed, usual day and nothing new. This type of l\ anguage is an )Tj 1 0 0 1 34.32001 674.12 Tm (indicator that the provision of care is task orientated and de personali\ sed.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (We asked how staff get the information they need about people and their \ needs if they )Tj 1 0 0 1 34.32001 621.63 Tm (do not read care plans. They told us they know people, or get to know th\ em. They say )Tj 1 0 0 1 34.32001 604.14001 Tm (they do not get a handover of information when they come on duty, that o\ nly the )Tj 1 0 0 1 34.32001 586.64001 Tm (nurse gets this. They say they start work straight away. They know who n\ eeds getting )Tj 1 0 0 1 34.32001 569.14996 Tm (up and who needs breakfast. We asked the temporary manager how it is ens\ ure that )Tj 1 0 0 1 34.32001 551.64996 Tm (carers have the information they need to care for people and were told t\ hat she would )Tj 1 0 0 1 34.32001 534.14996 Tm (hope nurses give this. This means there is not a robust system in place \ to ensure that )Tj 1 0 0 1 34.32001 516.65997 Tm (care staff have the information and guidance they need to ensure that pe\ ople's needs )Tj 1 0 0 1 34.32001 499.16 Tm (are met.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We saw that care plans are reviewed by nurses. However, we noted that de\ spite )Tj 1 0 0 1 34.32001 446.66998 Tm (changes in people's conditions that there were no changes to the plans o\ f care. We )Tj 1 0 0 1 34.32001 429.17999 Tm (also noted that reviews of care plans do not record what information has\ been used to )Tj 1 0 0 1 34.32001 411.67999 Tm (make the nursing decisions.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (The pharmacist inspector inspected the way that medicines are managed in\ this home. )Tj 1 0 0 1 34.32001 359.19 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 341.70001 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 324.20001 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 306.70999 Tm (were told that sometimes people can look after and take their own medici\ nes. There )Tj 1 0 0 1 34.32001 289.20999 Tm (are not any people living in the home at the moment who do this, and peo\ ple are )Tj 1 0 0 1 34.32001 271.70999 Tm (given their medicines by nursing staff.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (Medicines are stored safely for the protection of people in the home. Th\ ere are )Tj 1 0 0 1 34.32001 219.23 Tm (suitable arrangements for controlled drugs and any medicines requiring c\ old-storage.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Records are kept of medicines received into the home, and of any unwante\ d medicines )Tj 1 0 0 1 34.32001 166.73999 Tm (that are sent for destruction. Records are kept of medicines that are gi\ ven to people, )Tj 1 0 0 1 34.32001 149.23999 Tm (which helps to show that people receive their medicines as prescribed by\ the doctor. If )Tj 1 0 0 1 34.32001 131.75 Tm (a regularly prescribed dose is omitted, then a reason for this is record\ ed, as is good )Tj 1 0 0 1 34.32001 114.25 Tm (practice. Usually if a variable dose is prescribed there are clear recor\ ds to show how )Tj 1 0 0 1 34.32001 96.75 Tm (much is given, and this too is good practice.)Tj ET endstream endobj 823 0 obj 4862 endobj 824 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 686.21997 w 34.60001 468.30002 m 562.53998 468.30002 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 664.84998 w 33.47 456.47998 m 563.65997 456.47998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 121.86 l S 564.78998 791.10999 m 564.78998 121.86 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 122.93001 m 565.87 122.93001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We looked at some people's care plans to see what information is recorde\ d about their )Tj 1 0 0 1 34.32001 744.10999 Tm (medicines. We found written permission from the doctor to crush someone'\ s tablets )Tj 1 0 0 1 34.32001 726.60999 Tm (before giving. Staff had not asked if other forms of the same medicines \ are available, )Tj 1 0 0 1 34.32001 709.10999 Tm (such as soluble tablets or liquids, to make it easier for people to take\ . We found clear )Tj 1 0 0 1 34.32001 691.62 Tm (guidance for staff on when to administer medication that was prescribed \ to be given )Tj 1 0 0 1 34.32001 674.12 Tm ('when required'. This helps to show that people receive their medicines \ in the way )Tj 1 0 0 1 34.32001 656.63 Tm (their doctor intended for them.)Tj 1 0 0 1 34.32001 639.13 Tm (\240)Tj 1 0 0 1 34.32001 621.63 Tm (We looked at how people's privacy and dignity is maintained. We heard pe\ ople being )Tj 1 0 0 1 34.32001 604.14001 Tm (called by their preferred names and some people were able to tell us the\ y wear their )Tj 1 0 0 1 34.32001 586.64001 Tm (own clothes. We saw staff discreetly helping some people go to the toile\ t. However, )Tj 1 0 0 1 34.32001 569.14996 Tm (we also saw one person trying to attract the attention of staff who walk\ ed past or said )Tj 1 0 0 1 34.32001 551.64996 Tm ('hang on' as they walked past and did not come back. We heard one person\ saying no )Tj 1 0 0 1 34.32001 534.14996 Tm (repeatedly and we heard a carer saying 'yes, yes, yes' in a mocking fash\ ion.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We saw in the care plans of two people that they like to be or are washe\ d, shaved, )Tj 1 0 0 1 34.32001 481.66998 Tm (have their hair brushed and dressed whilst sitting on the commode. This \ is not a )Tj 1 0 0 1 34.32001 464.16998 Tm (dignified way to provide care. In addition a record of names of people w\ ho had taken )Tj 1 0 0 1 34.32001 446.66998 Tm (a bath is kept in the communal bathroom. This indicates an institutional\ approach to )Tj 1 0 0 1 34.32001 429.17999 Tm (people's personal care needs and to their confidentiality.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (We saw one person being hoisted to be taken to the toilet. When raised o\ ut of their )Tj 1 0 0 1 34.32001 376.69 Tm (seat there was a strong smell of urine. After they left the lounge, the \ smell persisted. )Tj 1 0 0 1 34.32001 359.19 Tm (We smelt the chair and found that the smell was coming from the fabric o\ f the chair, )Tj 1 0 0 1 34.32001 341.70001 Tm (and from the pressure relieving cushion on the chair. When staff returne\ d they put )Tj 1 0 0 1 34.32001 324.20001 Tm (this person back onto the chair. Each time this person shifted their wei\ ght in their )Tj 1 0 0 1 34.32001 306.70999 Tm (chair, there was an unpleasant odour of stale urine released.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj 1 0 0 1 34.32001 271.70999 Tm (We saw that two people share a bedroom. There are no records to show tha\ t each )Tj 1 0 0 1 34.32001 254.22 Tm (person has been consulted or made an informed choice about this, as shou\ ld happen. )Tj 1 0 0 1 34.32001 236.72 Tm (We saw that the room can be divided by a curtain. When we asked one pers\ on if this )Tj 1 0 0 1 34.32001 219.23 Tm (was used, they told us that it isn't always. Although this person says t\ hey don't mind, )Tj 1 0 0 1 34.32001 201.73 Tm (it is unclear what the other person sharing this room thinks or feels ab\ out this as they )Tj 1 0 0 1 34.32001 184.23 Tm (have communication difficulties.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (One health care professional commented that sometimes shared rooms creat\ e )Tj 1 0 0 1 34.32001 131.75 Tm (problems around privacy and dignity. )Tj ET endstream endobj 825 0 obj 5858 endobj 826 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 437.25 m 562.53998 437.25 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 119.35001 w 33.47 426 m 563.65997 426 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 364.12 l S 564.78998 487.87988 m 564.78998 364.12 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 365.20001 m 565.87 365.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Some people's quality of life is enhanced by continued links with their \ families and )Tj 1 0 0 1 36.62 409.25 Tm (friends and by the activities they take part in. However, not everyone i\ s having their )Tj 1 0 0 1 36.62 391.75998 Tm (individual social needs and rights to make choices met.)Tj 1 0 0 1 36.62 374.25998 Tm (People enjoy an appetising, balanced diet that meets their nutritional n\ eeds.)Tj 1 0 0 1 28.35001 349.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 257.30002 w 34.60001 210.67998 m 562.53998 210.67998 l S 1 1 1 RG 22.5 w 32.35001 330.32999 m 564.78998 330.32999 l S 235.92998 w 33.47 198.87 m 563.65997 198.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 317.95999 m 565.87 317.95999 l S 32.35001 319.03998 m 32.35001 78.70001 l S 564.78998 319.03998 m 564.78998 78.70001 l S 32.35001 317.95999 m 564.78998 317.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 327.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 302.26999 Tm (Since the last inspection the home has employed an activities co-ordinat\ or for 20 )Tj 1 0 0 1 36.57001 284.78 Tm (hours each week. This person is responsible for meeting the social needs\ of all the )Tj 1 0 0 1 36.57001 267.28 Tm (people living here and provides support with helping people to eat and w\ ith personal )Tj 1 0 0 1 36.57001 249.78998 Tm (care such as cutting people's nails.)Tj 1 0 0 1 36.57001 232.28998 Tm (\240)Tj 1 0 0 1 36.57001 214.78998 Tm (In surveys people told us there are usually activities they can take par\ t in if they want )Tj 1 0 0 1 36.57001 197.3 Tm (to. We saw that about 4 people who spend their time in the lounge are we\ ll attended )Tj 1 0 0 1 36.57001 179.8 Tm (to. We saw people took part in a picture quiz, in card games and in phys\ ical activity. )Tj 1 0 0 1 36.57001 162.31 Tm (These people were having fun, were being included, were relaxed and were\ treated )Tj 1 0 0 1 36.57001 144.81 Tm (with respect and with warmth. We saw that one person in particular is re\ ally )Tj 1 0 0 1 36.57001 127.31 Tm (benefiting from having this social interaction.)Tj 1 0 0 1 36.57001 109.82001 Tm (\240)Tj 1 0 0 1 36.57001 92.32001 Tm (We also saw the the lounge is laid out in such a way that separate areas\ have been )Tj ET endstream endobj 827 0 obj 4934 endobj 828 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (created. This means that people can take part in different activities or\ have )Tj 1 0 0 1 34.32001 761.60004 Tm (conversations without disturbing anyone else, and away from the televisi\ on. The )Tj 1 0 0 1 34.32001 744.10999 Tm (television was on throughout the day during this inspection. It was set \ to a very high )Tj 1 0 0 1 34.32001 726.60999 Tm (volume and no one was watching it. One person did take an interest when \ the )Tj 1 0 0 1 34.32001 709.10999 Tm (lunchtime news came on. They told us they like to hear the news, but tha\ t they're not )Tj 1 0 0 1 34.32001 691.62 Tm (bothered otherwise.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We saw one person enjoying knitting who also benefited from the activiti\ es organised. )Tj 1 0 0 1 34.32001 639.13 Tm (Other people were invited to join in and declined or were unable to do s\ o due to their )Tj 1 0 0 1 34.32001 621.63 Tm (disabilities.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (Other people living in this home spend time in their rooms. We spoke wit\ h staff about )Tj 1 0 0 1 34.32001 569.14996 Tm (how these people are supported to have their social needs met. We were t\ old the )Tj 1 0 0 1 34.32001 551.64996 Tm (activities co-ordinator spends time with these people in their rooms. We\ found that, )Tj 1 0 0 1 34.32001 534.14996 Tm (whilst well intentioned and very skillful, this person cannot meet the s\ ocial needs of all )Tj 1 0 0 1 34.32001 516.65997 Tm (the people living here. People who are physically or mentally disabled s\ pend long )Tj 1 0 0 1 34.32001 499.16 Tm (periods alone.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (One person told us they get bored lying in bed all day. Their relative s\ aid that staff )Tj 1 0 0 1 34.32001 446.66998 Tm (come into the room, but that this is to carry out care tasks such as tur\ ning. The care )Tj 1 0 0 1 34.32001 429.17999 Tm (plan for this person does not contain any information about their intere\ sts or religious )Tj 1 0 0 1 34.32001 411.67999 Tm (or spiritual needs.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Other care plans contain some information about people's interests. Howe\ ver, )Tj 1 0 0 1 34.32001 359.19 Tm (knowledge about these interests is not being used to meet each person's \ need to be )Tj 1 0 0 1 34.32001 341.70001 Tm (engaged and be social in an individualised way.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (For example each care plan has sections about people's spiritual needs. \ The care plan )Tj 1 0 0 1 34.32001 289.20999 Tm (of one person who has dementia states they are very religious and identi\ fies their )Tj 1 0 0 1 34.32001 271.70999 Tm (religion. The care plan section relating to social needs records that th\ is person loves to )Tj 1 0 0 1 34.32001 254.22 Tm (go out. The care plan does not identify how this person will be supporte\ d to attend a )Tj 1 0 0 1 34.32001 236.72 Tm (religious service or how they will be helped to go out. Staff tell us th\ is person does not )Tj 1 0 0 1 34.32001 219.23 Tm (go to church and does not go out. In addition, the part of the care plan\ relating to )Tj 1 0 0 1 34.32001 201.73 Tm (people's death and dying needs states that this person should be encoura\ ged to )Tj 1 0 0 1 34.32001 184.23 Tm (express their wishes regarding death as it approaches. This statement is\ used in all )Tj 1 0 0 1 34.32001 166.73999 Tm (the care plans we looked at where the section on death and dying had bee\ n )Tj 1 0 0 1 34.32001 149.23999 Tm (completed. This person's plan makes no mention of the arrangements this \ person )Tj 1 0 0 1 34.32001 131.75 Tm (might like in relation to their religion.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (Another person's care plan does not identify their social interests and \ we saw that this )Tj ET endstream endobj 829 0 obj 5000 endobj 830 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (person spent the day at the home in the lounge without being engaged in \ any activity.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We asked staff how decisions are made about who gets up early or late. S\ taff told us )Tj 1 0 0 1 34.32001 726.60999 Tm ('the diabetics are always got up first and that after that it depends on\ where the )Tj 1 0 0 1 34.32001 709.10999 Tm (member of staff decides to start work'. This indicates that people are n\ ot offered )Tj 1 0 0 1 34.32001 691.62 Tm (choice.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We found that the care plan for one person contains a recently written s\ tatement that )Tj 1 0 0 1 34.32001 639.13 Tm (they like to get up at 6am. It also states that the nurse writing this h\ as discussed this )Tj 1 0 0 1 34.32001 621.63 Tm (with the person and that they agree with this. This person is described \ in the care plan )Tj 1 0 0 1 34.32001 604.14001 Tm (as having dementia and being confused. We found this statement in the ca\ re plan of )Tj 1 0 0 1 34.32001 586.64001 Tm (another person who is also described as having dementia. This means that\ people who )Tj 1 0 0 1 34.32001 569.14996 Tm (cannot speak up for themselves do not make decisions and do not have con\ trol over )Tj 1 0 0 1 34.32001 551.64996 Tm (their individual daily lives.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj 1 0 0 1 34.32001 516.65997 Tm (Visitors told us they can visit when they like. And we saw visitors in t\ he home at )Tj 1 0 0 1 34.32001 499.16 Tm (different times of the day and evening. Some people say that staff keep \ them up to )Tj 1 0 0 1 34.32001 481.66998 Tm (date with changes and developments and others say that staff don't do th\ is.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (In surveys people told us they always like the food served in the home. \ People we )Tj 1 0 0 1 34.32001 429.17999 Tm (spoke with say they like the variety and the quality of food served. We \ heard staff )Tj 1 0 0 1 34.32001 411.67999 Tm (asking people what they would like for lunch, close to the time this was\ being served. )Tj 1 0 0 1 34.32001 394.19 Tm (This means that people are helped to make a choice about what to eat at \ a time when )Tj 1 0 0 1 34.32001 376.69 Tm (they are ready to make this decision and when it means something to them\ . We were )Tj 1 0 0 1 34.32001 359.19 Tm (unsure how staff helped people who cannot speak for themselves to make d\ ecisions )Tj 1 0 0 1 34.32001 341.70001 Tm (about what to eat. We asked a member of care staff who told us that they\ get to know )Tj 1 0 0 1 34.32001 324.20001 Tm (what people like. We saw in care plans that there are records about some\ people's )Tj 1 0 0 1 34.32001 306.70999 Tm (likes and dislikes, but not for all people. We saw records relating to w\ hat one person )Tj 1 0 0 1 34.32001 289.20999 Tm (eats. We saw that they have porridge for breakfast every day as far back\ as we saw )Tj 1 0 0 1 34.32001 271.70999 Tm (records for \(approximately 11 weeks\). They had also had scrambled egg \ for supper for )Tj 1 0 0 1 34.32001 254.22 Tm (the majority of those 11 weeks. Staff told us that this person sometimes\ does not eat )Tj 1 0 0 1 34.32001 236.72 Tm (much at supper and on the day of this inspection staff told us this pers\ on only ate 2 )Tj 1 0 0 1 34.32001 219.23 Tm (small spoonfuls of supper. The records and conversations with staff do n\ ot indicate )Tj 1 0 0 1 34.32001 201.73 Tm (that staff had explored the possibility that this person might be bored \ with their )Tj 1 0 0 1 34.32001 184.23 Tm (supper diet.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We heard that one person who spends all their time in their bedroom had \ not had )Tj 1 0 0 1 34.32001 131.75 Tm (breakfast on two occasions and that their morning tea had been missed a \ couple of )Tj 1 0 0 1 34.32001 114.25 Tm (times.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 831 0 obj 1224 endobj 832 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We also saw two people being supported to eat by staff whilst in their b\ edrooms. The )Tj 1 0 0 1 34.32001 761.60004 Tm (support given was unhurried, relaxed and sensitive. )Tj ET endstream endobj 833 0 obj 5679 endobj 834 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 505.73999 m 562.53998 505.73999 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 84.36 w 33.47 494.5 m 563.65997 494.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 450.12 l S 564.78998 538.88 m 564.78998 450.12 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 451.19 m 565.87 451.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People concerns are not always acted upon and people are not fully safeg\ uarded from )Tj 1 0 0 1 36.62 460.25 Tm (harm. )Tj 1 0 0 1 28.35001 435.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 343.30002 w 34.60001 253.67 m 562.53998 253.67 l S 1 1 1 RG 22.5 w 32.35001 416.31998 m 564.78998 416.31998 l S 321.92999 w 33.47 241.86 m 563.65997 241.86 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 403.94998 m 565.87 403.94998 l S 32.35001 405.03 m 32.35001 78.70001 l S 564.78998 405.03 m 564.78998 78.70001 l S 32.35001 403.94998 m 564.78998 403.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 413.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 388.26999 Tm (In surveys all 3 people told us that they know how to make a formal comp\ laint and 2 )Tj 1 0 0 1 36.57001 370.76999 Tm (told us there is someone they can speak with informally if they are not \ happy. One )Tj 1 0 0 1 36.57001 353.26999 Tm (person said they can only do this with their visitors.)Tj 1 0 0 1 36.57001 335.78 Tm (\240)Tj 1 0 0 1 36.57001 318.28 Tm (The information given to us in the AQAA tells us that this home has rece\ ived one )Tj 1 0 0 1 36.57001 300.78998 Tm (complaint since the last inspection a year ago. This was dealt with by t\ he home within )Tj 1 0 0 1 36.57001 283.29001 Tm (28 days, which is the timescale set, and it was upheld. It also tells us\ that one )Tj 1 0 0 1 36.57001 265.79001 Tm (safeguarding alert was made alleging that someone living at the home was\ not )Tj 1 0 0 1 36.57001 248.3 Tm (receiving care that was safe. This was investigated by the safeguarding \ team in May )Tj 1 0 0 1 36.57001 230.8 Tm (2009. The outcome of this was that the care provided was not neglectful \ or abusive, )Tj 1 0 0 1 36.57001 213.31 Tm (but was poor practice.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Since then the commission has received two complaints about the quality \ of care, )Tj 1 0 0 1 36.57001 160.81999 Tm (about staff not being available when needed, about the management of med\ icines and )Tj 1 0 0 1 36.57001 143.31999 Tm (about the general management of the home. One person said they had bough\ t their )Tj 1 0 0 1 36.57001 125.83 Tm (concerns to the attention of staff but did not get a satisfactory respon\ se. Another )Tj 1 0 0 1 36.57001 108.33 Tm (person said they thought that staff were not taking their concerns serio\ usly enough.)Tj 1 0 0 1 36.57001 90.83 Tm (\240)Tj ET endstream endobj 835 0 obj 5335 endobj 836 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We have looked at some of these issues during this inspection and are wo\ rking with )Tj 1 0 0 1 34.32001 761.60004 Tm (the safeguarding team who are undertaking an investigation relating to t\ hese )Tj 1 0 0 1 34.32001 744.10999 Tm (allegations. In addition Devon County Council are reviewing the care of \ the people )Tj 1 0 0 1 34.32001 726.60999 Tm (living here.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (The AQAA tells us that no one living here is subject to any form of rest\ raint. However, )Tj 1 0 0 1 34.32001 674.12 Tm (a referral was made under the Deprivation of Liberty and Mental Capacity\ Act because )Tj 1 0 0 1 34.32001 656.63 Tm (one person is being restrained in their wheelchair. This is not a depriv\ ation of liberty )Tj 1 0 0 1 34.32001 639.13 Tm (but is a form of restraint. We saw that this continues. We also saw in a\ care plan that )Tj 1 0 0 1 34.32001 621.63 Tm (another person is restrained in their chair by using a lap belt when the\ y try to stand )Tj 1 0 0 1 34.32001 604.14001 Tm (up. We saw that people have bed rails whilst in their beds, which is ano\ ther form of )Tj 1 0 0 1 34.32001 586.64001 Tm (restraint. There is some indication that the restraint used for people w\ hilst sitting in )Tj 1 0 0 1 34.32001 569.14996 Tm (their chairs might not always be appropriate. This is because records st\ ate that it is )Tj 1 0 0 1 34.32001 551.64996 Tm (used when people try to stand up or get agitated. The use of restraint i\ s sometimes )Tj 1 0 0 1 34.32001 534.14996 Tm (the only action that can be taken to keep someone safe. However, records\ should )Tj 1 0 0 1 34.32001 516.65997 Tm (show that all other actions to reduce risk have been tried before this a\ ction is taken. )Tj 1 0 0 1 34.32001 499.16 Tm (In addition, care plans do not give clear and specific instructions as t\ o when restraint )Tj 1 0 0 1 34.32001 481.66998 Tm (should be used and for how long. We asked staff about the use of restrai\ nt in the form )Tj 1 0 0 1 34.32001 464.16998 Tm (of a lap belt for one person. They told us that they use it only when ne\ eded, when )Tj 1 0 0 1 34.32001 446.66998 Tm (staff are not around, and for a few hours. This means that restraint is \ being used for )Tj 1 0 0 1 34.32001 429.17999 Tm (long periods when staff are not around to supervise vulnerable and agita\ ted people.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (People who live here are having decisions about forms of restraint made \ by staff or )Tj 1 0 0 1 34.32001 376.69 Tm (relatives. Sometimes this has to happen if the person involved is not ab\ le to make )Tj 1 0 0 1 34.32001 359.19 Tm (these decisions for themselves. The circumstances of these decisions sho\ uld be )Tj 1 0 0 1 34.32001 341.70001 Tm (recorded so that it is clear that these decisions are being made in the \ best interests of )Tj 1 0 0 1 34.32001 324.20001 Tm (that person. Such records are not being kept for people living in this h\ ome.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We saw three people who have bruises or broken skin. We asked staff abou\ t these. )Tj 1 0 0 1 34.32001 271.70999 Tm (They gave us explanations for two but staff did not know what had caused\ the third )Tj 1 0 0 1 34.32001 254.22 Tm (injury. We saw in care records that one person's injury had been caused \ when they )Tj 1 0 0 1 34.32001 236.72 Tm (had resisted care. The circumstances of this have not been investigated \ and actions )Tj 1 0 0 1 34.32001 219.23 Tm (have not been taken to prevent this happening again. Another person inju\ red them )Tj 1 0 0 1 34.32001 201.73 Tm (self on a bed rail and there are no records to show that actions have be\ en taken to )Tj 1 0 0 1 34.32001 184.23 Tm (prevent this happening again.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We spoke with staff about what they would do if they saw or suspected ab\ use. They )Tj 1 0 0 1 34.32001 131.75 Tm (told us they would tell the nurse in charge, as is good practice. We ask\ ed the nurse in )Tj 1 0 0 1 34.32001 114.25 Tm (charge what they would do, and the actions they describe are contrary to\ the guidance )Tj 1 0 0 1 34.32001 96.75 Tm (given in the multi-agency guidance. This person told us that they had re\ ceived )Tj ET endstream endobj 837 0 obj 1252 endobj 838 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (training and had a copy of the guidance in the home. However, the guidan\ ce they )Tj 1 0 0 1 34.32001 761.60004 Tm (showed us would not guide them to take appropriate action if abuse were \ suspected. )Tj ET endstream endobj 839 0 obj 5720 endobj 840 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 488.73999 m 562.53998 488.73999 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 84.36 w 33.47 477.5 m 563.65997 477.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 433.12 l S 564.78998 521.88 m 564.78998 433.12 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 434.19 m 565.87 434.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (People living here enjoy a homely environment. However, improvements are\ needed )Tj 1 0 0 1 36.62 443.25 Tm (to ensure that people are fully protected from infection. )Tj 1 0 0 1 28.35001 418.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 326.30002 w 34.60001 245.17 m 562.53998 245.17 l S 1 1 1 RG 22.5 w 32.35001 399.31998 m 564.78998 399.31998 l S 304.92999 w 33.47 233.36 m 563.65997 233.36 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 386.94998 m 565.87 386.94998 l S 32.35001 388.03 m 32.35001 78.70001 l S 564.78998 388.03 m 564.78998 78.70001 l S 32.35001 386.94998 m 564.78998 386.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 396.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 371.26999 Tm (In surveys people told us that the home is usually clean and fresh. On t\ he day we )Tj 1 0 0 1 36.57001 353.76999 Tm (visited we found it to be clean and odour free.)Tj 1 0 0 1 36.57001 336.26999 Tm (\240)Tj 1 0 0 1 36.57001 318.78 Tm (The home is warm, and is furnished and decorated in a domestic and homel\ y style. )Tj 1 0 0 1 36.57001 301.28 Tm (There is a reception area in the large hall, where there is usually a me\ mber of staff )Tj 1 0 0 1 36.57001 283.79001 Tm (during the day so that people visiting the home can speak with them. The\ re is also a )Tj 1 0 0 1 36.57001 266.29001 Tm (large board in the hall displaying the photographs and names of the staf\ f working at )Tj 1 0 0 1 36.57001 248.78998 Tm (the home. This is helpful so that people can identify and become familia\ r with staff.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The home has one large lounge and a dining room. Both are decorated and \ furnished )Tj 1 0 0 1 36.57001 196.31 Tm (in a homely style. The tables in the dining room are smaller and this he\ lps people to )Tj 1 0 0 1 36.57001 178.81 Tm (sit in smaller groups and to experience meals as a social occasion. The \ lounge is )Tj 1 0 0 1 36.57001 161.31 Tm (divided into smaller seating areas so that people can carry out differen\ t activities )Tj 1 0 0 1 36.57001 143.81999 Tm (without disturbing others. This area is very bright as it has large wind\ ows to the side )Tj 1 0 0 1 36.57001 126.32001 Tm (and rear of the house.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (We saw staff washing their hands and wearing protective clothing as a wa\ y of helping )Tj ET endstream endobj 841 0 obj 2517 endobj 842 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (to prevent the spread of infection. Staff use alcohol gel as another way\ of preventing )Tj 1 0 0 1 34.32001 761.60004 Tm (the spread of infection, and this is also available for visitors to the \ home to use.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we saw that the sluice did not have liquid soap for staff to wa\ sh their hands, )Tj 1 0 0 1 34.32001 709.10999 Tm (and that some soap dispensers appear dirty and one was empty.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last inspection by the commission the home have also been visi\ ted by the )Tj 1 0 0 1 34.32001 656.63 Tm (fire authority. Some actions were required and these have been carried o\ ut. We saw )Tj 1 0 0 1 34.32001 639.13 Tm (that access from the home is controlled at the front door by a key pad s\ ystem and )Tj 1 0 0 1 34.32001 621.63 Tm (were told that this is linked to the fire alarm. This means that when th\ e fire alarm )Tj 1 0 0 1 34.32001 604.14001 Tm (sounds that the door lock will automatically be opened, and is good prac\ tice.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We were told that some areas of the home have been redecorated. We saw o\ ne )Tj 1 0 0 1 34.32001 551.64996 Tm (upstairs window being replaced. We saw that staff test and record the te\ mperature of )Tj 1 0 0 1 34.32001 534.14996 Tm (bathing water as is good practice to ensure that accidental scalding is \ prevented. )Tj ET endstream endobj 843 0 obj 5784 endobj 844 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 480 m 562.53998 480 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 101.85001 w 33.47 468.75 m 563.65997 468.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 415.62 l S 564.78998 521.88 m 564.78998 415.62 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 416.70001 m 565.87 416.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (There are not always enough staff on duty with the appropriate qualifica\ tions, training )Tj 1 0 0 1 36.62 443.25 Tm (and skills to care for people living here. Practices in relation to recr\ uitment are placing )Tj 1 0 0 1 36.62 425.75998 Tm (people at risk of harm. )Tj 1 0 0 1 28.35001 401.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 308.80002 w 34.60001 236.42998 m 562.53998 236.42998 l S 1 1 1 RG 22.5 w 32.35001 381.82999 m 564.78998 381.82999 l S 287.42999 w 33.47 224.62 m 563.65997 224.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 369.44998 m 565.87 369.44998 l S 32.35001 370.53 m 32.35001 78.70001 l S 564.78998 370.53 m 564.78998 78.70001 l S 32.35001 369.44998 m 564.78998 369.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 378.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 353.76999 Tm (This is a nursing home and should have a registered nurse on duty throug\ hout the day )Tj 1 0 0 1 36.57001 336.26999 Tm (and night. We were contacted by a person who was concerned this was not \ )Tj 1 0 0 1 36.57001 318.78 Tm (happening. We contacted the home and it was confirmed that on one night \ there was )Tj 1 0 0 1 36.57001 301.28 Tm (not a nurse on duty. We asked the owner why they had not used an agency \ nurse to )Tj 1 0 0 1 36.57001 283.79001 Tm (cover this shift. They told us that this home never uses agency staff. T\ hey told us that )Tj 1 0 0 1 36.57001 266.29001 Tm (due to staff sickness they had arranged for a nurse to sleep at the home\ on that night. )Tj 1 0 0 1 36.57001 248.78998 Tm (This practice puts people at risk.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The caller was also concerned that there are not enough staff on duty. W\ e spoke to )Tj 1 0 0 1 36.57001 196.31 Tm (the owner about this. She told us that staffing has been reduced but tha\ t there are )Tj 1 0 0 1 36.57001 178.81 Tm (enough staff on duty to meet people's current needs. We looked at the du\ ty rota and )Tj 1 0 0 1 36.57001 161.31 Tm (saw that there had previously been 3 or 4 carers on duty in the morning \ and this had )Tj 1 0 0 1 36.57001 143.81999 Tm (been reduced to 2 or 3 carers. In the afternoon we saw that there used t\ o be 2 or 3 )Tj 1 0 0 1 36.57001 126.32001 Tm (carers on duty in the afternoon, and now there are 2. On the day of this\ inspection )Tj 1 0 0 1 36.57001 108.83 Tm (there was a nurse on duty with 3 carers, an administrator, cook and the \ temporary )Tj 1 0 0 1 36.57001 91.33 Tm (manager.)Tj ET endstream endobj 845 0 obj 4923 endobj 846 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We saw in the information given to us by the home prior to the inspectio\ n that there )Tj 1 0 0 1 34.32001 744.10999 Tm (are 14 people living at the home who need help with undressing and dress\ ing, and )Tj 1 0 0 1 34.32001 726.60999 Tm (need help to go to the toilet. 11 people are incontinent of both faeces \ and urine and 8 )Tj 1 0 0 1 34.32001 709.10999 Tm (people have dementia. 11 people need two members of staff to help them w\ ith their )Tj 1 0 0 1 34.32001 691.62 Tm (care.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (In surveys one person told us that staff are usually available, one that\ staff are )Tj 1 0 0 1 34.32001 639.13 Tm (sometimes available and one that staff are never available when needed. \ Comments )Tj 1 0 0 1 34.32001 621.63 Tm (included staff are not always available, and the home is very short of s\ taff. The )Tj 1 0 0 1 34.32001 604.14001 Tm (surveys also asked what the home could do better. People said employ mor\ e staff who )Tj 1 0 0 1 34.32001 586.64001 Tm (can speak and understand English and train and employ more staff especia\ lly at night. )Tj 1 0 0 1 34.32001 569.14996 Tm (Staff were however described as nice and lovely.)Tj 1 0 0 1 34.32001 551.64996 Tm (\240)Tj 1 0 0 1 34.32001 534.14996 Tm (We looked at the records relating to falls and injuries. According to th\ ese records )Tj 1 0 0 1 34.32001 516.65997 Tm (people have been found to have fallen when there have been no staff pres\ ent on 14 )Tj 1 0 0 1 34.32001 499.16 Tm (separate occasions since the beginning of July this year. This means tha\ t people are )Tj 1 0 0 1 34.32001 481.66998 Tm (not being sufficiently supervised by staff to keep them safe.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We know that these accident records are incomplete. We are aware that on\ e person )Tj 1 0 0 1 34.32001 429.17999 Tm (has fallen whilst alone, and this is not recorded. We also saw that two \ people had )Tj 1 0 0 1 34.32001 411.67999 Tm (injuries which have not been recorded as accidents or incidents.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We looked at the duty rota and found that is is not always accurate. For\ example, on )Tj 1 0 0 1 34.32001 359.19 Tm (some weeks the manager, who has left the home, is recorded as on duty. I\ n addition, )Tj 1 0 0 1 34.32001 341.70001 Tm (the temporary manager has not been included on the duty rota until Septe\ mber )Tj 1 0 0 1 34.32001 324.20001 Tm (although they say they started work at the home in August.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We asked to see the records of staff training. We were told that these a\ re incomplete )Tj 1 0 0 1 34.32001 271.70999 Tm (because the records about training have gone missing since the manager l\ eft the )Tj 1 0 0 1 34.32001 254.22 Tm (home. We saw that some records had been made about training, but that th\ ere were )Tj 1 0 0 1 34.32001 236.72 Tm (large gaps. The management team tell us that this means they are not ful\ ly aware of )Tj 1 0 0 1 34.32001 219.23 Tm (what training staff have had, and what training might be needed. We did \ see a notice )Tj 1 0 0 1 34.32001 201.73 Tm (that said that training has been arranged for staff in relation preventi\ ng people from )Tj 1 0 0 1 34.32001 184.23 Tm (falling.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (Staff told us they had had some training. One told us they had had train\ ing in how to )Tj 1 0 0 1 34.32001 131.75 Tm (provide care to people, another that they thought they had had training \ in relation to )Tj 1 0 0 1 34.32001 114.25 Tm (supporting people who have problems with swallowing. However, they went \ on to )Tj 1 0 0 1 34.32001 96.75 Tm (describe training which relates to nutritional supplements. One person t\ hought they )Tj ET endstream endobj 847 0 obj 2380 endobj 848 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 266.32001 w 34.60001 678.25 m 562.53998 678.25 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 244.93999 w 33.47 666.44 m 563.65997 666.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 541.76001 l S 564.78998 791.10999 m 564.78998 541.76001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 542.83997 m 565.87 542.83997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (had had training about dementia, and gave a description of how to care f\ or someone )Tj 1 0 0 1 34.32001 761.60004 Tm (with dementia which was an example of good practice.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we also saw that staff record that people have drunk more than \ they have. )Tj 1 0 0 1 34.32001 709.10999 Tm (We heard staff trying to persuade a confused person that their understan\ ding of a )Tj 1 0 0 1 34.32001 691.62 Tm (situation was wrong, causing distress and confusion to this person. We a\ lso saw staff )Tj 1 0 0 1 34.32001 674.12 Tm (ignoring one person who was trying to attract their attention.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (The AQAA told us that 10 of the 12 carers working at this home have achi\ eved a )Tj 1 0 0 1 34.32001 621.63 Tm (National Vocational Qualification \(NVQ\) in care, to level 2 or above. \ We asked the )Tj 1 0 0 1 34.32001 604.14001 Tm (manager if there is a system in place to ensure that staff practice the \ skills they are )Tj 1 0 0 1 34.32001 586.64001 Tm (taught, and to ensure they do this to the level of quality that is expec\ ted. The )Tj 1 0 0 1 34.32001 569.14996 Tm (manager told us that this is the nurses responsibility and that there is\ no formal )Tj 1 0 0 1 34.32001 551.64996 Tm (system.)Tj ET endstream endobj 849 0 obj 5831 endobj 850 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 395 m 562.53998 395 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 101.85001 w 33.47 383.75 m 563.65997 383.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 330.62 l S 564.78998 436.88 m 564.78998 330.62 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 331.70001 m 565.87 331.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of leadership in this home means that systems are not in place to e\ nsure that )Tj 1 0 0 1 36.62 358.25 Tm (people receive the care they need to an acceptable standard in a way tha\ t promotes )Tj 1 0 0 1 36.62 340.75998 Tm (their safety. )Tj 1 0 0 1 28.35001 316.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.8 w 34.60001 193.92999 m 562.53998 193.92999 l S 1 1 1 RG 22.5 w 32.35001 296.82999 m 564.78998 296.82999 l S 202.42998 w 33.47 182.12 m 563.65997 182.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 284.44998 m 565.87 284.44998 l S 32.35001 285.53 m 32.35001 78.70001 l S 564.78998 285.53 m 564.78998 78.70001 l S 32.35001 284.44998 m 564.78998 284.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.76999 Tm (This home does not have a Registered Manager. The previous manager left \ in August )Tj 1 0 0 1 36.57001 251.26999 Tm (2009. Since that time the home has been managed on a temporary basis. Th\ e )Tj 1 0 0 1 36.57001 233.78 Tm (temporary manager is a Registered Nurse and is studying for a Leadership\ and )Tj 1 0 0 1 36.57001 216.28 Tm (Management qualification. She had been working as the \(unregistered\) m\ anager of )Tj 1 0 0 1 36.57001 198.78998 Tm (the owners' residential home, and works from 9am - 3pm four days weekly.\ She is )Tj 1 0 0 1 36.57001 181.28998 Tm (supernumerary to nursing hours and is supported by two of the four owner\ s of this )Tj 1 0 0 1 36.57001 163.78999 Tm (home, who are also nurses.)Tj 1 0 0 1 36.57001 146.3 Tm (\240)Tj 1 0 0 1 36.57001 128.8 Tm (In the last few months the commission has received comments from relativ\ es of )Tj 1 0 0 1 36.57001 111.31 Tm (people living here who say the overall management of the home has declin\ ed. One )Tj 1 0 0 1 36.57001 93.81 Tm (person described the management as chaotic, saying that this has resulte\ d in people )Tj ET endstream endobj 851 0 obj 5070 endobj 852 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (not getting the care they need.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked to see if there are systems in place to ensure the home runs e\ fficiently and )Tj 1 0 0 1 34.32001 726.60999 Tm (safely, and that people get the care they need. We found that systems ar\ e not robust )Tj 1 0 0 1 34.32001 709.10999 Tm (enough to achieve this.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (For example we looked at the system for communicating peoples' needs and\ changing )Tj 1 0 0 1 34.32001 656.63 Tm (needs, and for ensuring that peoples' needs are met. The owners and mana\ ger told us )Tj 1 0 0 1 34.32001 639.13 Tm (that this is achieved through the care planning system. However, we foun\ d that these )Tj 1 0 0 1 34.32001 621.63 Tm (documents are complex and contradictory in places. They do not always pr\ ovide the )Tj 1 0 0 1 34.32001 604.14001 Tm (level of detail needed by staff to ensure that they have the information\ they need, and )Tj 1 0 0 1 34.32001 586.64001 Tm (to ensure that people's needs are met in a way that is consistent and of\ a satisfactory )Tj 1 0 0 1 34.32001 569.14996 Tm (quality. We found that reviews of people's care do not include all the i\ nformation )Tj 1 0 0 1 34.32001 551.64996 Tm (available and do not always provide evidence for some of the care decisi\ ons made )Tj 1 0 0 1 34.32001 534.14996 Tm (\(see Health and Personal Care\). Care staff told us they do not read ca\ re plans. We )Tj 1 0 0 1 34.32001 516.65997 Tm (asked if they got a hand over of information at the beginning of each sh\ ift and they )Tj 1 0 0 1 34.32001 499.16 Tm (told us they do not. We asked the manager how information is relayed to \ staff. She )Tj 1 0 0 1 34.32001 481.66998 Tm (told us that she expects the nurses to do this. The evidence in the Heal\ th and Personal )Tj 1 0 0 1 34.32001 464.16998 Tm (Care section of this report, shows that this is not happening.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked closely at how some decisions about people's care are made. Fo\ r example, )Tj 1 0 0 1 34.32001 411.67999 Tm (one record states that one person cannot make a decision about having be\ d rails on )Tj 1 0 0 1 34.32001 394.19 Tm (their bed. However, records show that this person has made a decision ab\ out having )Tj 1 0 0 1 34.32001 376.69 Tm (repeated invasive procedures. Another person can make the decision to ge\ t up at 6am )Tj 1 0 0 1 34.32001 359.19 Tm (but cannot make a decision about what they eat.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at how risks in the home are managed. We found that people are\ identified )Tj 1 0 0 1 34.32001 306.70999 Tm (as being at risk of falling. Care records instruct staff to observe them\ . Records show )Tj 1 0 0 1 34.32001 289.20999 Tm (that a lot of falls have happened to people when staff are not present. \ Although there )Tj 1 0 0 1 34.32001 271.70999 Tm (is a system for recording this information, there is not a system for mo\ nitoring and )Tj 1 0 0 1 34.32001 254.22 Tm (analysing this information, and therefore actions have not been taken to\ help prevent )Tj 1 0 0 1 34.32001 236.72 Tm (and reduce the number of falls.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (We looked to see if there is a safe system in place for moving and handl\ ing people )Tj 1 0 0 1 34.32001 184.23 Tm (with mobility problems. We found that assessments have not been carried \ out or had )Tj 1 0 0 1 34.32001 166.73999 Tm (been carried out a long time ago and have not been reviewed. We found th\ at decisions )Tj 1 0 0 1 34.32001 149.23999 Tm (about the type of equipment to be used are based on the equipment that i\ s available )Tj 1 0 0 1 34.32001 131.75 Tm (and not on what would be the most suitable for each person. The manager \ reports )Tj 1 0 0 1 34.32001 114.25 Tm (that staff have not had training in how to carry out moving and handling\ assessments.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 853 0 obj 5058 endobj 854 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We looked at how other risks in the home have been managed. We found tha\ t the )Tj 1 0 0 1 34.32001 761.60004 Tm (temperature of hot water is restricted to help ensure that people are no\ t scalded. We )Tj 1 0 0 1 34.32001 744.10999 Tm (found that windows have restricted openings to prevent people falling. H\ owever, we )Tj 1 0 0 1 34.32001 726.60999 Tm (found one window, that had been replaced that day, did not have a restri\ cted opening. )Tj 1 0 0 1 34.32001 709.10999 Tm (We told one of the owners who told us they thought that it had been rest\ ricted since )Tj 1 0 0 1 34.32001 691.62 Tm (we last looked. When we looked again, it had not.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked in the kitchen and found it clean and tidy. The owners identif\ ied )Tj 1 0 0 1 34.32001 639.13 Tm (approximately 4 years ago that the kitchen is coming to the end of its u\ seful life, and )Tj 1 0 0 1 34.32001 621.63 Tm (the Environmental Health Officer also identified this. The cook reports \ that a )Tj 1 0 0 1 34.32001 604.14001 Tm (refurbishment date has not yet been set.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We looked at how equipment is maintained. We found that the weighing sca\ les had )Tj 1 0 0 1 34.32001 551.64996 Tm (been weighing inaccurately for some time meaning that people at risk of \ malnutrition )Tj 1 0 0 1 34.32001 534.14996 Tm (could not be weighed accurately. The lift broke down for at least 2 days\ in October.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We looked at how the home involve people in the running of the home and \ how the )Tj 1 0 0 1 34.32001 481.66998 Tm (management team get feedback from people and improve the quality of care\ given. )Tj 1 0 0 1 34.32001 464.16998 Tm (We were told by relatives that meetings are sometimes held to which they\ are invited. )Tj 1 0 0 1 34.32001 446.66998 Tm (One person told us at that at the last meeting they had been informed th\ ere were )Tj 1 0 0 1 34.32001 429.17999 Tm (going to be a lot of changes in the home. They asked for, and the manage\ ment team )Tj 1 0 0 1 34.32001 411.67999 Tm (agreed they could have, a list of these changes so that they could prepa\ re their parent )Tj 1 0 0 1 34.32001 394.19 Tm (for these changes. They have not received this.)Tj 1 0 0 1 34.32001 376.69 Tm (\240)Tj 1 0 0 1 34.32001 359.19 Tm (We looked at the results of the most recent quality assurance survey \(J\ une 2009\). )Tj 1 0 0 1 34.32001 341.70001 Tm (Some people had said they were not satisfied with the length of time it \ took to answer )Tj 1 0 0 1 34.32001 324.20001 Tm (call bells. One person said that new staff were not given enough trainin\ g meaning that )Tj 1 0 0 1 34.32001 306.70999 Tm (they had to take instruction from the person they were meant to be carin\ g for. Two )Tj 1 0 0 1 34.32001 289.20999 Tm (people thought that improvements should be made to laundry and one to ir\ oning. We )Tj 1 0 0 1 34.32001 271.70999 Tm (asked how these issues had been addressed and the owner did not know bec\ ause the )Tj 1 0 0 1 34.32001 254.22 Tm (survey was carried out when the previous manager was employed.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We checked to see if previous requirements set by the commission have be\ en met. )Tj 1 0 0 1 34.32001 201.73 Tm (We found that requirements relating to health and welfare, care planning\ , )Tj 1 0 0 1 34.32001 184.23 Tm (safeguarding people, meeting people's social needs, staff skills and imp\ roving the )Tj 1 0 0 1 34.32001 166.73999 Tm (overall management have not been met.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We did not check any personal allowance accounts of the people living he\ re as the )Tj 1 0 0 1 34.32001 114.25 Tm (home does not hold any money on behalf of people. Instead they run a deb\ it account, )Tj 1 0 0 1 34.32001 96.75 Tm (recording all monies spent on people's behalf. Records and receipts are \ given to )Tj ET endstream endobj 855 0 obj 1648 endobj 856 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (35)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 126.35001 w 34.60001 748.22998 m 562.53998 748.22998 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 104.98 w 33.47 736.41998 m 563.65997 736.41998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 681.72998 l S 564.78998 791.10999 m 564.78998 681.72998 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 682.81 m 565.87 682.81 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (relatives and supporters for them to check and to pay for retrospectivel\ y.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (During our inspection it came to light that the commission are not being\ notified of all )Tj 1 0 0 1 34.32001 726.60999 Tm (incidents that affect the welfare of people living here as they should b\ e. In addition )Tj 1 0 0 1 34.32001 709.10999 Tm (the owners of the home have not been carrying out monthly unannounced vi\ sits to the )Tj 1 0 0 1 34.32001 691.62 Tm (home as they should, They have since informed us that they plan to resta\ rt these. )Tj ET endstream endobj 857 0 obj 6476 endobj 858 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (36)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 494.10001 784.77997 l S 0.95294 0.95294 0.95294 RG 496.34998 784.77997 m 539.10004 784.77997 l S 1 1 1 RG 541.34998 784.77997 m 566.10004 784.77997 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 794.40002 m 568.29999 794.40002 l S 26.14 813.64996 m 568.29999 813.64996 l S 26.14 794.40002 m 568.29999 794.40002 l S 26.14 775.14996 m 568.29999 775.14996 l S 27.22 814.72998 m 27.22 774.07996 l S 423.22 795.47998 m 423.22 774.07996 l S 468.22 795.47998 m 468.22 774.07996 l S 495.22 795.47998 m 495.22 774.07996 l S 540.21997 795.47998 m 540.21997 774.07996 l S 567.21997 814.72998 m 567.21997 774.07996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 33.75 800.46997 Tm (Are there any outstanding requirements from the last inspection?)Tj 1 0 0 1 429.75 781.21997 Tm (Yes)Tj /C2_0 12 Tf 1 0 0 1 476.37 783.15997 Tm <0035>Tj /T1_0 12 Tf 1 0 0 1 501.75 781.21997 Tm (No)Tj /C2_0 12 Tf 1 0 0 1 546.75 783.15997 Tm <0085>Tj ET 0.95294 0.95294 0.95294 RG 654.5 w 32.32001 391.28 m 564.96997 391.28 l S 1 1 1 RG 183.95999 w 31.2 523.69 m 91.05 523.69 l S 93.3 523.69 m 197.40001 523.69 l S 199.64998 523.69 m 289.44998 523.69 l S 291.70001 523.69 m 473.80002 523.69 l S 476.04999 523.69 m 566.10004 523.69 l S 300.60001 w 31.2 279.16 m 91.05 279.16 l S 93.3 279.16 m 197.40001 279.16 l S 199.64998 279.16 m 289.44998 279.16 l S 291.70001 279.16 m 473.80002 279.16 l S 476.04999 279.16 m 566.10004 279.16 l S 63.71001 w 31.2 94.75999 m 91.05 94.75999 l S 93.3 94.75999 m 197.40001 94.75999 l S 199.64998 94.75999 m 289.44998 94.75999 l S 291.70001 94.75999 m 473.80002 94.75999 l S 476.04999 94.75999 m 566.10004 94.75999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 430.59 m 568.29999 430.59 l S 28.99001 127.74001 m 568.29999 127.74001 l S 30.07001 617.88 m 30.07001 60.7 l S 567.21997 617.88 m 567.21997 60.7 l S 28.99001 649.34998 m 568.40002 649.34998 l S 28.99001 616.79999 m 568.29999 616.79999 l S 92.17 617.88 m 92.17 60.7 l S 198.51999 617.88 m 198.51999 60.7 l S 290.57001 617.88 m 290.57001 60.7 l S 474.91998 617.88 m 474.91998 60.7 l S 28.99001 720.77997 m 568.40002 720.77997 l S 28.99001 649.34998 m 568.40002 649.34998 l S 28.99001 616.79999 m 568.40002 616.79999 l S 28.99001 430.59 m 568.29999 430.59 l S 28.99001 127.74001 m 568.29999 127.74001 l S 28.99001 61.78 m 568.29999 61.78 l S 30.07001 721.85999 m 30.07001 615.71997 l S 92.12 650.42999 m 92.12 615.71997 l S 198.51999 650.42999 m 198.51999 615.71997 l S 290.62 650.42999 m 290.62 615.71997 l S 475.01999 650.42999 m 475.01999 615.71997 l S 567.32001 721.85999 m 567.32001 615.71997 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 703.57001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 685.14996 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 670.57001 Tm (been met.)Tj 1 0 0 1 95.57001 670.57001 Tm (\240 )Tj 1 0 0 1 104.02 670.57001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 655.98999 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 638.16998 Tm (No.)Tj 1 0 0 1 96.10001 635.16998 Tm (Standard)Tj 1 0 0 1 202.5 635.16998 Tm (Regulation)Tj 1 0 0 1 294.60001 635.16998 Tm (Requirement)Tj 1 0 0 1 479 635.16998 Tm (Timescale for )Tj 1 0 0 1 479 623.01996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 603.60999 Tm (1)Tj 1 0 0 1 96.15001 600.60999 Tm (7)Tj 1 0 0 1 202.5 600.60999 Tm (15)Tj 1 0 0 1 294.54999 600.60999 Tm (\(1\) People who have )Tj 1 0 0 1 294.54999 586.02997 Tm (dementia must have their )Tj 1 0 0 1 294.54999 571.45001 Tm (care planned in a way that is )Tj 1 0 0 1 294.54999 556.87 Tm (person centred; 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They )Tj 1 0 0 1 294.54999 448.95999 Tm (must record their findings )Tj 1 0 0 1 294.54999 434.38 Tm (and send these to the )Tj 1 0 0 1 294.54999 419.80002 Tm (commission after each visit.)Tj 1 0 0 1 294.54999 405.22 Tm (\240)Tj 1 0 0 1 294.54999 390.63998 Tm (Previous timescale of )Tj 1 0 0 1 294.54999 376.06 Tm (13/04/07 not met.)Tj 1 0 0 1 294.54999 361.47998 Tm (\240)Tj 1 0 0 1 294.54999 346.89999 Tm (Not inspected on this )Tj 1 0 0 1 294.54999 332.32001 Tm (occasion. 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This )Tj 1 0 0 1 298.04999 446.73999 Tm (assessment must include )Tj 1 0 0 1 298.04999 429.73999 Tm (health and social care )Tj 1 0 0 1 298.04999 412.73999 Tm (assessments if the )Tj 1 0 0 1 298.04999 395.73999 Tm (placement takes place )Tj 1 0 0 1 298.04999 378.73999 Tm (through health or social care )Tj 1 0 0 1 298.04999 361.73999 Tm (services. )Tj 1 0 0 1 298.04999 344.73999 Tm (\240)Tj 1 0 0 1 298.04999 327.73999 Tm (This will help to ensure that )Tj 1 0 0 1 298.04999 310.73999 Tm (each person's needs are )Tj 1 0 0 1 298.04999 293.73999 Tm (identified and can be met. )Tj 1 0 0 1 482.10001 514.73999 Tm (07/12/2009)Tj 1 0 0 1 554.04999 514.73999 Tm (\240)Tj 1 0 0 1 35.5 274.48999 Tm (2)Tj 1 0 0 1 99.3 274.48999 Tm (7)Tj 1 0 0 1 201.55 274.48999 Tm (15)Tj 1 0 0 1 298.04999 274.48999 Tm (You must ensure that care )Tj 1 0 0 1 298.04999 257.48999 Tm (plans provide clear and up )Tj 1 0 0 1 298.04999 240.48999 Tm (to date instructions on how )Tj 1 0 0 1 298.04999 223.48999 Tm (each person's care needs )Tj 1 0 0 1 298.04999 206.48999 Tm (are to be met, recorded and )Tj 1 0 0 1 298.04999 189.48999 Tm (monitored. Information )Tj 1 0 0 1 298.04999 172.48999 Tm (recorded in care plans must )Tj 1 0 0 1 298.04999 155.48999 Tm (be relevant and appropriate. )Tj 1 0 0 1 298.04999 138.48999 Tm (All parts of the care plan )Tj 1 0 0 1 298.04999 121.49001 Tm (must be reviewed and )Tj 1 0 0 1 298.04999 104.49001 Tm (updated as appropriate. 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239.06998 Tm (4)Tj 1 0 0 1 96.15001 239.06998 Tm (30)Tj 1 0 0 1 202.5 239.06998 Tm (You must ensure that staff have had the training they need )Tj 1 0 0 1 202.5 224.48999 Tm (to care for people appropriately.)Tj ET endstream endobj 877 0 obj 1872 endobj 878 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (46)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 22.5 w 22.95 802.40997 m 560.45001 802.40997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 28.35001 799.08997 Tm (Helpline:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 28.35001 781.10999 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 28.35001 759.60004 Tm (Telephone:)Tj 0 Tr 1 0 0 1 95.88 759.60004 Tm ( 03000 616161)Tj 2 Tr 1 0 0 1 28.35001 739.60004 Tm (Email:)Tj 0 Tr 1 0 0 1 66.84 739.60004 Tm ( enquiries@cqc.org.uk)Tj 2 Tr 1 0 0 1 28.35001 719.60999 Tm (Web:)Tj 0 Tr 1 0 0 1 64.35001 719.60999 Tm (www.cqc.org.uk)Tj 1 0 0 1 28.35001 699.60999 Tm (\240)Tj 1 0 0 1 28.35001 679.60999 Tm (We want people to be able to access this information. If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 879 0 obj 4539 endobj 880 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 73.32001 w 31.2 470.10999 m 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for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. 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Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 885 0 obj 9115 endobj 886 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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281.29001 m 534.54999 281.29001 l S 536.79999 281.29001 m 565.90002 281.29001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 292.70001 m 568.10004 292.70001 l S 28.99001 269.87 m 568.10004 269.87 l S 30.07001 293.78 m 30.07001 268.80002 l S 316.37 293.78 m 316.37 268.80002 l S 347.66998 293.78 m 347.66998 268.80002 l S 379.01999 293.78 m 379.01999 268.80002 l S 410.31998 293.78 m 410.31998 268.80002 l S 441.66998 293.78 m 441.66998 268.80002 l S 473.01999 293.78 m 473.01999 268.80002 l S 504.31998 293.78 m 504.31998 268.80002 l S 535.66998 293.78 m 535.66998 268.80002 l S 567.01996 293.78 m 567.01996 268.80002 l S BT /T1_0 12 Tf 1 0 0 1 34.05 276.51999 Tm (Date of last inspection)Tj 1 0 0 1 328.20001 276.51999 Tm (0)Tj 1 0 0 1 359.53 276.51999 Tm (4)Tj 1 0 0 1 390.85999 276.51999 Tm (1)Tj 1 0 0 1 422.17999 276.51999 Tm (1)Tj 1 0 0 1 453.53 276.51999 Tm (2)Tj 1 0 0 1 484.85999 276.51999 Tm (0)Tj 1 0 0 1 516.17999 276.51999 Tm (0)Tj 1 0 0 1 547.52997 276.51999 Tm (8)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 258 m 565.90002 258 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 248.37 m 568.10004 248.37 l S 30.07001 249.45 m 30.07001 39.14999 l S 567.01996 249.45 m 567.01996 39.14999 l S 28.99001 267.62 m 568.10004 267.62 l S 28.99001 248.37 m 568.10004 248.37 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 268.70001 m 30.07001 247.28998 l S 567.01996 268.70001 m 567.01996 247.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 254.43999 Tm (Brief description of the )Tj 1 0 0 1 177.31 254.43999 Tm (care home)Tj 1 0 0 1 35.5 235.18999 Tm (Honiton Manor is registered to provide 24 hour nursing care for up to 22\ service users )Tj 1 0 0 1 35.5 218.19 Tm (who have needs relating to 'older people'.)Tj 1 0 0 1 35.5 201.19 Tm (\240)Tj 1 0 0 1 35.5 184.19 Tm (The two-storey home is an older style building situated on the main road\ into, and )Tj 1 0 0 1 35.5 167.19 Tm (quite close to, Honiton and the local amenities. It is on public transpo\ rt routes.)Tj 1 0 0 1 35.5 150.19 Tm (\240)Tj 1 0 0 1 35.5 133.19 Tm (There are eleven single bedrooms and five double bedrooms situated on th\ e ground )Tj 1 0 0 1 35.5 116.19 Tm (and first floors. One of the double bedrooms has an ensuite bathroom. A \ passenger lift )Tj 1 0 0 1 35.5 99.19 Tm (and a staircase link the floors.)Tj 1 0 0 1 35.5 82.19 Tm (\240)Tj 1 0 0 1 35.5 65.19 Tm (Communal space is made up of a large lounge and a dining room, both on t\ he ground )Tj 1 0 0 1 35.5 48.19 Tm (floor.)Tj ET endstream endobj 887 0 obj 1404 endobj 888 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 689.07996 l S 567.01996 795.47998 m 567.01996 689.07996 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 690.14996 m 568.10004 690.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (\240)Tj 1 0 0 1 33.25 766.46997 Tm (Outside there is access to a seating area and parking.)Tj 1 0 0 1 33.25 749.46997 Tm (\240)Tj 1 0 0 1 33.25 732.46997 Tm (Current charges are \243515.00 - \243675.00 per week. Charges do not inc\ lude items such )Tj 1 0 0 1 33.25 715.46997 Tm (as newspapers, toiletries, taxis etc.)Tj 1 0 0 1 33.25 698.46997 Tm (\240)Tj ET endstream endobj 889 0 obj 3597 endobj 890 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (This unannounced key inspection was due to be undertaken in November 200\ 9. It was )Tj 1 0 0 1 35.17 240.90001 Tm (bought forward as we had received some concerns about the quality of car\ e that )Tj 1 0 0 1 35.17 226.31998 Tm (people living here are receiving.)Tj 1 0 0 1 35.17 211.73999 Tm (\240)Tj 1 0 0 1 35.17 197.14998 Tm (During this visit we \(the commission\) spoke with or observed the major\ ity of people )Tj 1 0 0 1 35.17 182.56999 Tm (living here. We could not speak with some people because they have commu\ nication )Tj 1 0 0 1 35.17 167.98999 Tm (difficulties such as dementia. We looked closely at the care, services a\ nd )Tj 1 0 0 1 35.17 153.41 Tm (accommodation offered to four people living here. This is called case tr\ acking and helps )Tj 1 0 0 1 35.17 138.84 Tm (us to make a judgment about the standard of care overall, and helps us t\ o understand )Tj 1 0 0 1 35.17 124.25 Tm (the experiences of people who live here.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (We looked at the care and attention given by staff to these people and w\ e looked at )Tj 1 0 0 1 35.17 80.50999 Tm (their assessments and at their care planning records. We looked at the e\ nvironment in )Tj 1 0 0 1 35.17 65.93001 Tm (relation to their needs and how their health and personal care needs are\ met. We also )Tj ET endstream endobj 891 0 obj 2315 endobj 892 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 280.01999 w 32.32001 672.51996 m 566.71997 672.51996 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 531.38 m 568.91998 531.38 l S 31.2 814.72998 m 31.2 530.31 l S 567.84998 814.72998 m 567.84998 530.31 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (spoke with visitors to the home, with staff and with the manager and one\ of the )Tj 1 0 0 1 32.92 788.13995 Tm (owners. We visited the majority of bedrooms and saw all service and comm\ unal areas )Tj 1 0 0 1 32.92 773.56 Tm (of the home.)Tj 1 0 0 1 32.92 758.97998 Tm (\240)Tj 1 0 0 1 32.92 744.40002 Tm (We looked at records relating to accidents and incidents, staff training\ , staff )Tj 1 0 0 1 32.92 729.82001 Tm (recruitment, medication and at some policies.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (Prior to the inspection the owners sent us their Annual Quality Assuranc\ e Assessment )Tj 1 0 0 1 32.92 686.07996 Tm (\(AQAA\) which gave us information about the home and it's management an\ d about the )Tj 1 0 0 1 32.92 671.5 Tm (needs of people living here. This document asks for evidence in relation\ to what the )Tj 1 0 0 1 32.92 656.91998 Tm (home does well and what they think they can improve upon.)Tj 1 0 0 1 32.92 642.33997 Tm (\240)Tj 1 0 0 1 32.92 627.76001 Tm (In addition, we sent surveys to 8 people living here and 3 were returned\ . We sent 8 )Tj 1 0 0 1 32.92 613.17999 Tm (surveys to staff and 3 were returned. We sent 4 surveys to health and so\ cial care )Tj 1 0 0 1 32.92 598.60004 Tm (professionals and all were returned. Feedback and comments are included \ in the )Tj 1 0 0 1 32.92 584.01996 Tm (report.)Tj 1 0 0 1 32.92 569.44 Tm (\240)Tj 1 0 0 1 32.92 554.85999 Tm (During this inspection evidence was taken under the Police and Criminal \ Evidence Act )Tj 1 0 0 1 32.92 540.27997 Tm (and this has been considered under our enforcement procedures.)Tj ET endstream endobj 893 0 obj 6453 endobj 894 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 64.32001 w 32.32001 741.65997 m 566.71997 741.65997 l S 20.58 w 32.7 696.95996 m 569.34998 696.95996 l S 93.48 w 33.82001 637.67999 m 568.21997 637.67999 l S 20.58 w 33.45 578.40002 m 570.10004 578.40002 l S 501.84 w 34.57001 314.94998 m 568.96997 314.94998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 708.38 m 568.91998 708.38 l S 31.2 776.02997 m 31.2 707.29999 l S 31.2 708.38 m 569.34998 708.38 l S 32.7 685.54999 m 569.34998 685.54999 l S 31.62 685.54999 m 570.41998 685.54999 l S 31.62 589.82001 m 570.41998 589.82001 l S 33.45 566.98999 m 570.10004 566.98999 l S 33.45 589.82001 m 570.10004 589.82001 l S 32.37 566.98999 m 571.16998 566.98999 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 686.63 m 32.7 588.73999 l S 33.45 568.07001 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 707.29999 l S 569.34998 686.63 m 569.34998 588.73999 l S 570.10004 568.07001 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (This home is warm, clean and comfortable. Staff are described as nice an\ d caring and )Tj 1 0 0 1 35.17 744.17999 Tm (as doing their best. The home has a lot of nursing equipment such as adj\ ustable beds )Tj 1 0 0 1 35.17 729.60004 Tm (and pressure relieving mattresses. People really enjoy the food served h\ ere which is )Tj 1 0 0 1 35.17 715.01996 Tm (nutritious and offers variety. )Tj /T1_0 10 Tf 1 0 0 1 568.96997 740.10999 Tm (\240)Tj 1 0 0 1 31.2 694.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 692.19 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 695.40997 Tm (\240)Tj 1 0 0 1 31.2 636.13 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 669.35999 Tm (Since the last inspection the programme of redecoration has continued. W\ e saw that a )Tj 1 0 0 1 36.67 654.77997 Tm (window was being replaced and that the front door is now secured with a \ key pad type )Tj 1 0 0 1 36.67 640.20001 Tm (lock.)Tj 1 0 0 1 36.67 625.62 Tm (The home has employed a part time activities co-ordinator and this perso\ n's efforts are )Tj 1 0 0 1 36.67 611.03998 Tm (having an impact for some people.)Tj 1 0 0 1 36.67 596.45996 Tm (The Requirement made at the last inspection in relation to medicines has\ been met. )Tj /T1_0 10 Tf 1 0 0 1 570.46997 636.13 Tm (\240)Tj 1 0 0 1 31.2 576.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 573.63 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 313.38998 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 550.79999 Tm (This home does not have a registered manager and is not being sufficient\ ly well )Tj 1 0 0 1 37.42 536.21997 Tm (managed. This has resulted in people's health and welfare needs not alwa\ ys being )Tj 1 0 0 1 37.42 521.64001 Tm (assessed or met. The care planning and communicating systems in place ar\ e not )Tj 1 0 0 1 37.42 507.06 Tm (sufficiently robust to ensure that care staff have the information they \ need about )Tj 1 0 0 1 37.42 492.47998 Tm (people's care needs and how these should be met.)Tj 1 0 0 1 37.42 477.89993 Tm (\240)Tj 1 0 0 1 37.42 463.31998 Tm (Staff are well intentioned but are not always on duty in sufficient numb\ ers, and do not )Tj 1 0 0 1 37.42 448.73999 Tm (always have the support they need, to meet people's needs. On one night \ there was )Tj 1 0 0 1 37.42 434.16 Tm (not a waking Registered Nurse on duty. Staff are not recruited in a robu\ st way and this )Tj 1 0 0 1 37.42 419.57999 Tm (means that people are at risk of being cared for by inappropriate staff.\ )Tj 1 0 0 1 37.42 405 Tm (\240)Tj 1 0 0 1 37.42 390.41998 Tm (People are not always treated with dignity and their rights to make choi\ ces or to be )Tj 1 0 0 1 37.42 375.84 Tm (engaged and sociable are not always supported. Some people's sense of se\ lf and )Tj 1 0 0 1 37.42 361.25998 Tm (personal identity is in danger of being eroded by a system that is not a\ lways person )Tj 1 0 0 1 37.42 346.67999 Tm (centred and is sometimes institutionalised.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Complaints have been made to the commission by some people. They complai\ n that )Tj 1 0 0 1 37.42 302.94 Tm (the home is not well managed and the quality of care has declined. These\ concerns are )Tj 1 0 0 1 37.42 288.35999 Tm (being investigated by the local safeguarding team. This is the second sa\ feguarding )Tj 1 0 0 1 37.42 273.78 Tm (alert that has been made since the last inspection. Whilst this investig\ ation is ongoing, )Tj 1 0 0 1 37.42 259.20001 Tm (admissions to this home via health or social care services have been sus\ pended by )Tj 1 0 0 1 37.42 244.62 Tm (Adult and Community Services.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Staff training is not up to date and some specialist training is being d\ esignated to )Tj 1 0 0 1 37.42 200.87999 Tm (people who are not qualified or experienced to carry this out.)Tj 1 0 0 1 37.42 186.3 Tm (\240)Tj 1 0 0 1 37.42 171.72 Tm (Some working practices and systems are not ensuring people's safety. Thi\ s includes )Tj 1 0 0 1 37.42 157.14 Tm (moving and handling people, ensuring windows are restricted to prevent a\ ccidental )Tj 1 0 0 1 37.42 142.56 Tm (falls, the maintenance of equipment and risk assessments and actions in \ relation to the )Tj 1 0 0 1 37.42 127.98 Tm (use of restraint. Systems are not robust enough to ensure that it is cle\ ar which staff )Tj 1 0 0 1 37.42 113.40001 Tm (have received mandatory training and which have not. The system for reco\ rding and )Tj 1 0 0 1 37.42 98.82001 Tm (monitoring accidents and incidents is not being used to help prevent fur\ ther accidents.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (The commission have not been kept informed in relation to all incidents,\ accidents and )Tj ET endstream endobj 895 0 obj 2243 endobj 896 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 148.8 w 34.57001 738.13 m 568.96997 738.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 662.60004 m 571.16998 662.60004 l S 33.45 814.72998 m 33.45 661.52997 l S 570.10004 814.72998 m 570.10004 661.52997 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (deaths in the home, as we should be so that we can monitor this type of \ activity in the )Tj 1 0 0 1 35.17 788.13995 Tm (home.)Tj 1 0 0 1 35.17 773.56 Tm (\240)Tj 1 0 0 1 35.17 758.97998 Tm (Statutory Requirement Notices have been issued to the registered owners \ of this )Tj 1 0 0 1 35.17 744.40002 Tm (service. These Notices inform the providers that they have failed to com\ ply with the )Tj 1 0 0 1 35.17 729.82001 Tm (Care Home Regulations 2001 in relation to planning people's care and in \ relation to )Tj 1 0 0 1 35.17 715.23999 Tm (meeting people's health and welfare needs. The Statutory Requirement Not\ ices tell the )Tj 1 0 0 1 35.17 700.65997 Tm (providers what they must do and gives them dates by when the failures id\ entified must )Tj 1 0 0 1 35.17 686.07996 Tm (be addressed.)Tj 1 0 0 1 35.17 671.5 Tm (\240)Tj 1 0 0 1 28.35001 648.03998 Tm (\240)Tj 1 0 0 1 28.35001 628.04999 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 628.04999 Tm (care home)Tj 1 0 0 1 480.03998 628.04999 Tm ( is taking )Tj 1 0 0 1 28.35001 610.54999 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 590.56 Tm (\240)Tj 1 0 0 1 28.35001 570.56 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 570.56 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 550.56 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 550.56 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 530.57001 Tm (order line 0870 240 7535.)Tj ET endstream endobj 897 0 obj 1804 endobj 898 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 899 0 obj 5905 endobj 900 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (Some people move into this home without having their needs fully assesse\ d and )Tj 1 0 0 1 36.62 341.25 Tm (without agreement from the funding authority. This means that people can\ not be sure )Tj 1 0 0 1 36.62 323.75998 Tm (that their needs will be met in an appropriate way or that they will be \ staying in this )Tj 1 0 0 1 36.62 306.25998 Tm (home. )Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (In surveys two out of three people who live here told us that they had t\ he information )Tj 1 0 0 1 36.57001 216.78 Tm (they needed to decide if this was the home for them. In addition, two ou\ t of three )Tj 1 0 0 1 36.57001 199.28 Tm (health care professionals say that the home's assessment arrangements us\ ually )Tj 1 0 0 1 36.57001 181.78998 Tm (ensure that accurate information is gathered and that the right service \ is planned for )Tj 1 0 0 1 36.57001 164.28999 Tm (people. One health care professional told us that this always happens.)Tj 1 0 0 1 36.57001 146.78999 Tm (\240)Tj 1 0 0 1 36.57001 129.3 Tm (We were told that the home had admitted two people to this home without \ an )Tj 1 0 0 1 36.57001 111.8 Tm (assessment by and without the agreement of the funding authority. When w\ e looked )Tj 1 0 0 1 36.57001 94.31 Tm (at records we found these people had been admitted from a residential ho\ me owned )Tj ET endstream endobj 901 0 obj 2644 endobj 902 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 336.30002 w 34.60001 643.26001 m 562.53998 643.26001 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 314.92999 w 33.47 631.44 m 563.65997 631.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 471.78 l S 564.78998 791.10999 m 564.78998 471.78 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 472.85999 m 565.87 472.85999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (by the owners of this home.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We spoke with staff who told us that one of these people had moved here \ because )Tj 1 0 0 1 34.32001 726.60999 Tm (they have nursing needs and therefore need their care to be planned and \ delivered by )Tj 1 0 0 1 34.32001 709.10999 Tm (registered nurses.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We looked at the records of one of these people. We found that an assess\ ment of their )Tj 1 0 0 1 34.32001 656.63 Tm (nursing needs had not taken place prior to their admission, or since the\ ir admission. )Tj 1 0 0 1 34.32001 639.13 Tm (We found that all assessments in their records have been carried out in \ the home they )Tj 1 0 0 1 34.32001 621.63 Tm (used to live in.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (We could not speak with this person about their feelings about the move \ as they have )Tj 1 0 0 1 34.32001 569.14996 Tm (communication difficulties. We spoke with the relative of another person\ living here. )Tj 1 0 0 1 34.32001 551.64996 Tm (They told us that they had looked around the home and at the bedroom the\ person )Tj 1 0 0 1 34.32001 534.14996 Tm (would move into. They were able to ask questions about the home before d\ eciding this )Tj 1 0 0 1 34.32001 516.65997 Tm (was the right home. However, we noted that this person's care record did\ not contain )Tj 1 0 0 1 34.32001 499.16 Tm (pre admission information from health and social care professionals as i\ t should.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj ET endstream endobj 903 0 obj 5782 endobj 904 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 403.25 m 562.53998 403.25 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 119.35001 w 33.47 392 m 563.65997 392 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 330.12 l S 564.78998 453.88 m 564.78998 330.12 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 331.20001 m 565.87 331.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (Peoples' medicines are safely managed. However, some people are being pu\ t at risk )Tj 1 0 0 1 36.62 375.25 Tm (because their health and welfare needs are not being met. People do not \ have their )Tj 1 0 0 1 36.62 357.75998 Tm (care planned in a person centred way that treats them as individuals and\ are not )Tj 1 0 0 1 36.62 340.25998 Tm (always treated with dignity. )Tj 1 0 0 1 28.35001 315.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.3 w 34.60001 193.67999 m 562.53998 193.67999 l S 1 1 1 RG 22.5 w 32.35001 296.32999 m 564.78998 296.32999 l S 201.92998 w 33.47 181.87 m 563.65997 181.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 283.95999 m 565.87 283.95999 l S 32.35001 285.04001 m 32.35001 78.70001 l S 564.78998 285.04001 m 564.78998 78.70001 l S 32.35001 283.95999 m 564.78998 283.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.26999 Tm (In surveys people living here told us they usually get the care and supp\ ort they need )Tj 1 0 0 1 36.57001 250.78 Tm (and that they always or usually get the medical support they need.)Tj 1 0 0 1 36.57001 233.28 Tm (\240)Tj 1 0 0 1 36.57001 215.78998 Tm (Two health care professionals told us that people's health care needs ar\ e always )Tj 1 0 0 1 36.57001 198.28998 Tm (properly monitored and one told us this usually happens. Two also said t\ hat the staff )Tj 1 0 0 1 36.57001 180.78998 Tm (at the home seek advice and act on it to improve well being, and one sai\ d that this )Tj 1 0 0 1 36.57001 163.3 Tm (sometimes happened. Comments from health care professionals include that\ staff act )Tj 1 0 0 1 36.57001 145.8 Tm (promptly to get medical help for people who need it and that some people\ have )Tj 1 0 0 1 36.57001 128.31 Tm (blossomed since living here.)Tj 1 0 0 1 36.57001 110.81 Tm (\240)Tj 1 0 0 1 36.57001 93.31 Tm (We looked in depth at the care plans of four people living here. We also\ looked at )Tj ET endstream endobj 905 0 obj 5378 endobj 906 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (some others. We found that each person has a plan of care and that these\ contain a )Tj 1 0 0 1 34.32001 761.60004 Tm (large number and range of documents relating to care needs. However, the\ se )Tj 1 0 0 1 34.32001 744.10999 Tm (documents were not person centred, are sometimes contradictory and do no\ t always )Tj 1 0 0 1 34.32001 726.60999 Tm (provide care staff with the detailed information that they need to meet \ people's needs.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (For example one person that we case tracked has been admitted from the o\ wners' )Tj 1 0 0 1 34.32001 674.12 Tm (residential home. This person's care plan is the care plan from that hom\ e. Staff told us )Tj 1 0 0 1 34.32001 656.63 Tm (that the reason this person was admitted to this home was because staff \ believe that )Tj 1 0 0 1 34.32001 639.13 Tm (they need the 24 hour care of nurses. However, nurses have not devised a\ care plan )Tj 1 0 0 1 34.32001 621.63 Tm (as to how this person's nursing needs are to be met. In addition, inform\ ation recorded )Tj 1 0 0 1 34.32001 604.14001 Tm (in the daily notes from the residential home has not been followed up. B\ efore being )Tj 1 0 0 1 34.32001 586.64001 Tm (admitted to this home, it was recorded that this person has a urinary ca\ theter, is )Tj 1 0 0 1 34.32001 569.14996 Tm (prone to urinary tract infections and needs encouragement to drink. Two \ days before )Tj 1 0 0 1 34.32001 551.64996 Tm (being admitted it is recorded that this person had very strong and dark \ urine which )Tj 1 0 0 1 34.32001 534.14996 Tm (means this person may not be drinking enough fluid. This person has live\ d in this care )Tj 1 0 0 1 34.32001 516.65997 Tm (home for approximately 6 weeks and the care notes have not mentioned thi\ s person's )Tj 1 0 0 1 34.32001 499.16 Tm (urine. We asked staff about this and they told us that the night staff e\ mpty the )Tj 1 0 0 1 34.32001 481.66998 Tm (catheter bag and that they didn't know how much urine this person passed\ or what )Tj 1 0 0 1 34.32001 464.16998 Tm (colour it is.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked to see how much this person drinks in a day because the reside\ ntial care )Tj 1 0 0 1 34.32001 411.67999 Tm (home instructions state that they should be encouraged to drink to preve\ nt urinary )Tj 1 0 0 1 34.32001 394.19 Tm (tract infections. We saw records that show this person drinks between 20\ 0mls and )Tj 1 0 0 1 34.32001 376.69 Tm (1050mls in a day. The records do not contain instructions about how much\ this person )Tj 1 0 0 1 34.32001 359.19 Tm (should drink in a day. We asked carers how much this person should drink\ to keep )Tj 1 0 0 1 34.32001 341.70001 Tm (them healthy and they thought that this would be about 1000mls. We asked\ carers if )Tj 1 0 0 1 34.32001 324.20001 Tm (they knew how much this person had drunk in the past days and they said \ they did )Tj 1 0 0 1 34.32001 306.70999 Tm (not because the nurse totals up the amount drunk. A nurse has reviewed t\ he records )Tj 1 0 0 1 34.32001 289.20999 Tm (kept about this person and the amount they have drunk. They record, in d\ ifferent )Tj 1 0 0 1 34.32001 271.70999 Tm (places in the care plan, that they have drunk a fair amount, small amoun\ t and a good )Tj 1 0 0 1 34.32001 254.22 Tm (amount. However, these reviews do not appear to have taken into account \ the days )Tj 1 0 0 1 34.32001 236.72 Tm (when this person has only drunk 200mls, 350mls and 400mls. We have calcu\ lated )Tj 1 0 0 1 34.32001 219.23 Tm (that this person, according to their weight, should have at least 1880ml\ s to drink each )Tj 1 0 0 1 34.32001 201.73 Tm (day. We spoke with the temporary manager about how much people should dr\ ink. She )Tj 1 0 0 1 34.32001 184.23 Tm (told us she knows there is a calculation to work this out, but does not \ know what it is. )Tj 1 0 0 1 34.32001 166.73999 Tm (We also noted that records show that this person does not have a drink b\ etween 6pm )Tj 1 0 0 1 34.32001 149.23999 Tm (and 8 or 9am. This is a very long time for someone who has a catheter an\ d is prone to )Tj 1 0 0 1 34.32001 131.75 Tm (urinary tract infections.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (We observed this person on the day of this inspection. They had numerous\ drinks put )Tj ET endstream endobj 907 0 obj 5195 endobj 908 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (in front of them by members of staff. No encouragement to drink was give\ n by staff, )Tj 1 0 0 1 34.32001 761.60004 Tm (but was given by their wife. we would estimate that this person drank ap\ proximately )Tj 1 0 0 1 34.32001 744.10999 Tm (50mls between 10am and 1pm.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We also saw that other people do not have enough to drink.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We saw in care plans that people are assessed to see if they are at risk\ of developing )Tj 1 0 0 1 34.32001 656.63 Tm (pressure sores. We saw that people we had case tracked are at risk. Thes\ e people are )Tj 1 0 0 1 34.32001 639.13 Tm (cared for on pressure relieving mattresses and cushions as is good pract\ ice. Some )Tj 1 0 0 1 34.32001 621.63 Tm (people are also nursed on adjustable beds which is also good practice. W\ e were told )Tj 1 0 0 1 34.32001 604.14001 Tm (that one person has developed a pressure sore since coming to live here \ and that one )Tj 1 0 0 1 34.32001 586.64001 Tm (person came to the home having already developed a pressure sore. We loo\ ked at )Tj 1 0 0 1 34.32001 569.14996 Tm (some pressure relieving equipment. We found one mattress had been set to\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (maximum pressure indicating that the person using this mattress is heavy\ . When we )Tj 1 0 0 1 34.32001 534.14996 Tm (looked in care records we found that this person is very light. We asked\ staff how they )Tj 1 0 0 1 34.32001 516.65997 Tm (work out the pressure that the mattress should be set to. One person sai\ d they did )Tj 1 0 0 1 34.32001 499.16 Tm (not know, another said the person setting it up does it. We looked in ca\ re plans, in )Tj 1 0 0 1 34.32001 481.66998 Tm (people's bedrooms and on the mattress motors to see if staff have access\ to )Tj 1 0 0 1 34.32001 464.16998 Tm (instructions about the pressure each mattress should be set at. We did n\ ot find any )Tj 1 0 0 1 34.32001 446.66998 Tm (instructions.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We saw in care plans that some people are at risk of malnutrition. One p\ erson we case )Tj 1 0 0 1 34.32001 394.19 Tm (tracked is losing weight. The GP has been informed. However, the recomme\ ndations )Tj 1 0 0 1 34.32001 376.69 Tm (made by the specialist nutritional tool used \(MUST\) have not been foll\ owed. According )Tj 1 0 0 1 34.32001 359.19 Tm (to this person's level of risk they should be having specific drinks to \ supplement their )Tj 1 0 0 1 34.32001 341.70001 Tm (calorie intake. Records show that these are given intermittently and not\ routinely. We )Tj 1 0 0 1 34.32001 324.20001 Tm (asked staff if this person has supplement drinks and they said no.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We noted in another person's records that they had been having loose bow\ el motions )Tj 1 0 0 1 34.32001 271.70999 Tm (and saw and heard from a relative that they had been off their food. Rec\ ords also )Tj 1 0 0 1 34.32001 254.22 Tm (show that this person has been what is described as 'grumpy'. This perso\ n has been )Tj 1 0 0 1 34.32001 236.72 Tm (weighed weekly. Although the most recent weight shows a weight gain, the\ general )Tj 1 0 0 1 34.32001 219.23 Tm (trend is that this person is losing weight. There was no record to show \ that this is )Tj 1 0 0 1 34.32001 201.73 Tm (being addressed. Staff are not keeping records of what this person eats \ and drinks. A )Tj 1 0 0 1 34.32001 184.23 Tm (nurse had recorded that they had reviewed this care plan but had not tak\ en any action )Tj 1 0 0 1 34.32001 166.73999 Tm (to address these health issues. This means that this person's health is \ not being )Tj 1 0 0 1 34.32001 149.23999 Tm (monitored appropriately and might result in a delay in appropriate actio\ n being taken.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (Prior to this inspection, the owners provided us with an updated improve\ ment plan in )Tj 1 0 0 1 34.32001 96.75 Tm (relation to requirements made at the last inspection about meeting peopl\ e's nutritional )Tj ET endstream endobj 909 0 obj 5376 endobj 910 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs. This told us that the completion of the nutritional risk assessme\ nt tool \(MUST\) )Tj 1 0 0 1 34.32001 761.60004 Tm (and for taking action if risk is identified has been designated to the c\ atering manager. )Tj 1 0 0 1 34.32001 744.10999 Tm (This person, along with other staff in the home, has received training i\ n relation to )Tj 1 0 0 1 34.32001 726.60999 Tm (nutrition from a company that supplies nutritional supplements. However,\ this does )Tj 1 0 0 1 34.32001 709.10999 Tm (not qualify them to carry out these assessments or to determine the acti\ ons that )Tj 1 0 0 1 34.32001 691.62 Tm (should be taken.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (Another care plan recorded that one person stays in bed all day and does\ not get )Tj 1 0 0 1 34.32001 639.13 Tm (dressed. It states the reason for this as them being immobile and having\ contractures )Tj 1 0 0 1 34.32001 621.63 Tm (of their legs. Records do not include evidence that consideration has be\ en given, or )Tj 1 0 0 1 34.32001 604.14001 Tm (that actions have been taken, to make arrangements or find moving and ha\ ndling )Tj 1 0 0 1 34.32001 586.64001 Tm (equipment that might allow this person to move out of their bed.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We looked at other records relating to people with dementia. Care plans \ state for )Tj 1 0 0 1 34.32001 534.14996 Tm (example, that some people have a poor mental state and reduced powers of\ )Tj 1 0 0 1 34.32001 516.65997 Tm (comprehension. However, care plans do not provide a plan as to how these\ people's )Tj 1 0 0 1 34.32001 499.16 Tm (mental health and welfare needs are to be addressed or met. In addition,\ it has been )Tj 1 0 0 1 34.32001 481.66998 Tm (agreed on three people's behalf, who are described as confused or having\ dementia, )Tj 1 0 0 1 34.32001 464.16998 Tm (that they would like to get them up as early as 6am. One of these people\ has an )Tj 1 0 0 1 34.32001 446.66998 Tm (illness the symptoms of which include stiffness, especially in the morni\ ng and fatigue. )Tj 1 0 0 1 34.32001 429.17999 Tm (These symptoms do not seem to have been considered in the decision to ge\ t them up )Tj 1 0 0 1 34.32001 411.67999 Tm (early.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We observed that one person is at high risk of choking as they have diff\ iculty )Tj 1 0 0 1 34.32001 359.19 Tm (swallowing. This person was referred to the Speech and Language Therapis\ t \(SALT\) )Tj 1 0 0 1 34.32001 341.70001 Tm (some time ago. However, a visiting health care professional observed tha\ t staff were )Tj 1 0 0 1 34.32001 324.20001 Tm (not following the guidance given by the SALT. They asked this specialist\ to visit again. )Tj 1 0 0 1 34.32001 306.70999 Tm (Instructions were left for staff to follow as to how this person is to b\ e supported to )Tj 1 0 0 1 34.32001 289.20999 Tm (eat. We saw that some of this guidance is being put into practice. Howev\ er, we also )Tj 1 0 0 1 34.32001 271.70999 Tm (saw that some is not. For example, we saw that nurses saw a visitor offe\ ring this )Tj 1 0 0 1 34.32001 254.22 Tm (person a chocolate covered wafer. They did not explain to the visitor th\ at this might )Tj 1 0 0 1 34.32001 236.72 Tm (cause problems for this person's swallowing. We saw this person in their\ wheelchair, )Tj 1 0 0 1 34.32001 219.23 Tm (leaning over to one side after lunch. This person is meant to sit up for\ 30 mins after )Tj 1 0 0 1 34.32001 201.73 Tm (eating. We saw that a member of staff put this person to bed soon after \ lunch, lying )Tj 1 0 0 1 34.32001 184.23 Tm (down. We asked staff about how this person is supported to eat and not c\ hoke. They )Tj 1 0 0 1 34.32001 166.73999 Tm (told us what they knew, but did not know that this person should be sat \ up for 30mins )Tj 1 0 0 1 34.32001 149.23999 Tm (after they had eaten. Staff told us this person has a pureed diet which \ complies with )Tj 1 0 0 1 34.32001 131.75 Tm (the SALT instructions. They also told us that they give this person cake\ and biscuits, )Tj 1 0 0 1 34.32001 114.25 Tm (which puts this person at risk of choking. The care plan does not contai\ n instructions )Tj 1 0 0 1 34.32001 96.75 Tm (for staff about what to do if this person chokes. One carer told us they\ would use their )Tj ET endstream endobj 911 0 obj 5253 endobj 912 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (common sense and try a grab and thrust movement. A nurse told us she hop\ ed that )Tj 1 0 0 1 34.32001 761.60004 Tm (staff would know to call a nurse or 999. This lack of instruction means \ that there may )Tj 1 0 0 1 34.32001 744.10999 Tm (be a delay in this person getting appropriate help.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We asked the manager how staff have been given information about this pe\ rson's )Tj 1 0 0 1 34.32001 691.62 Tm (needs and risk of choking since the most recent visit by the SALT. We we\ re told that )Tj 1 0 0 1 34.32001 674.12 Tm (the nurses had been told about the special requirements for this person,\ and the )Tj 1 0 0 1 34.32001 656.63 Tm (nurses were named, and that they give this information to the carers. We\ saw from )Tj 1 0 0 1 34.32001 639.13 Tm (the duty rota that one of these nurses had been on sick leave over this \ period. The )Tj 1 0 0 1 34.32001 621.63 Tm (manager confirmed this adding that the nurses already knew about the adv\ ice. We )Tj 1 0 0 1 34.32001 604.14001 Tm (reminded her that the SALT referral was made again because staff were no\ t following )Tj 1 0 0 1 34.32001 586.64001 Tm (the advice given, and this was putting this person at risk of choking.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We saw in the improvement plan provided by the owners that staff have ha\ d training )Tj 1 0 0 1 34.32001 534.14996 Tm (from the SALT in supporting people who have difficulties swallowing. Thi\ s document )Tj 1 0 0 1 34.32001 516.65997 Tm (also tells us that further updates will be given by the catering manager\ . This person is )Tj 1 0 0 1 34.32001 499.16 Tm (not qualified to do this and this is not good practice. We have checked \ with the SALT )Tj 1 0 0 1 34.32001 481.66998 Tm (and they have told us that they are happy to provide further training if\ needed.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We saw that many people living here have mobility problems. We checked c\ are plans )Tj 1 0 0 1 34.32001 429.17999 Tm (to see if people had had their moving and handling needs assessed. We fo\ und that )Tj 1 0 0 1 34.32001 411.67999 Tm (some people had not had these needs assessed. We found another that was \ dated )Tj 1 0 0 1 34.32001 394.19 Tm (April 2007 which had not been reviewed or updated since that time. Care \ plans give )Tj 1 0 0 1 34.32001 376.69 Tm (very general instructions for care staff such as 'needs hoist'. They did\ not specify the )Tj 1 0 0 1 34.32001 359.19 Tm (type of hoist to be used or the size of sling. We spoke to a nurse about\ how staff know )Tj 1 0 0 1 34.32001 341.70001 Tm (which hoist and sling to use. The nurse told us that if a person is on t\ he ground floor )Tj 1 0 0 1 34.32001 324.20001 Tm (they use the hoist that is on that floor and that carers make a judgment\ about what )Tj 1 0 0 1 34.32001 306.70999 Tm (size sling to use. This means that carers are not being supported to ens\ ure that they )Tj 1 0 0 1 34.32001 289.20999 Tm (use the appropriate equipment for each person.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (We also noted that the hoist is often used to help people who have been \ incontinent of )Tj 1 0 0 1 34.32001 236.72 Tm (urine. We saw that people share slings which does not help to prevent th\ e spread of )Tj 1 0 0 1 34.32001 219.23 Tm (infection and indicates that care is de-personalised.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Care plans in this home are in two parts. There is a larger comprehensiv\ e part which )Tj 1 0 0 1 34.32001 166.73999 Tm (contains details relating to the person and the plan of care. There is a\ lso a day to day )Tj 1 0 0 1 34.32001 149.23999 Tm (record which the manager told us is what carers use. Instructions in the\ se smaller )Tj 1 0 0 1 34.32001 131.75 Tm (records contain task orientated information such as needs feeding, hoist\ , weekly )Tj 1 0 0 1 34.32001 114.25 Tm (weight and on fluid chart. These are not person centred and do not give \ care staff the )Tj 1 0 0 1 34.32001 96.75 Tm (information they need to provide individualised care based on each perso\ n's individual )Tj ET endstream endobj 913 0 obj 4999 endobj 914 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs and preferences.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (Carers told us they do not tend to read care plans, although they do wri\ te in them. For )Tj 1 0 0 1 34.32001 726.60999 Tm (example they record fluid and food intake if people need to have this re\ corded. We )Tj 1 0 0 1 34.32001 709.10999 Tm (found that entries made by staff include impersonal comments such as pad\ changed, )Tj 1 0 0 1 34.32001 691.62 Tm (repositioned, soaking wet bed, usual day and nothing new. This type of l\ anguage is an )Tj 1 0 0 1 34.32001 674.12 Tm (indicator that the provision of care is task orientated and de personali\ sed.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (We asked how staff get the information they need about people and their \ needs if they )Tj 1 0 0 1 34.32001 621.63 Tm (do not read care plans. They told us they know people, or get to know th\ em. They say )Tj 1 0 0 1 34.32001 604.14001 Tm (they do not get a handover of information when they come on duty, that o\ nly the )Tj 1 0 0 1 34.32001 586.64001 Tm (nurse gets this. They say they start work straight away. They know who n\ eeds getting )Tj 1 0 0 1 34.32001 569.14996 Tm (up and who needs breakfast. We asked the temporary manager how it is ens\ ure that )Tj 1 0 0 1 34.32001 551.64996 Tm (carers have the information they need to care for people and were told t\ hat she would )Tj 1 0 0 1 34.32001 534.14996 Tm (hope nurses give this. This means there is not a robust system in place \ to ensure that )Tj 1 0 0 1 34.32001 516.65997 Tm (care staff have the information and guidance they need to ensure that pe\ ople's needs )Tj 1 0 0 1 34.32001 499.16 Tm (are met.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We saw that care plans are reviewed by nurses. However, we noted that de\ spite )Tj 1 0 0 1 34.32001 446.66998 Tm (changes in people's conditions that there were no changes to the plans o\ f care. We )Tj 1 0 0 1 34.32001 429.17999 Tm (also noted that reviews of care plans do not record what information has\ been used to )Tj 1 0 0 1 34.32001 411.67999 Tm (make the nursing decisions.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (The pharmacist inspector inspected the way that medicines are managed in\ this home. )Tj 1 0 0 1 34.32001 359.19 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 341.70001 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 324.20001 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 306.70999 Tm (were told that sometimes people can look after and take their own medici\ nes. There )Tj 1 0 0 1 34.32001 289.20999 Tm (are not any people living in the home at the moment who do this, and peo\ ple are )Tj 1 0 0 1 34.32001 271.70999 Tm (given their medicines by nursing staff.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (Medicines are stored safely for the protection of people in the home. Th\ ere are )Tj 1 0 0 1 34.32001 219.23 Tm (suitable arrangements for controlled drugs and any medicines requiring c\ old-storage.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Records are kept of medicines received into the home, and of any unwante\ d medicines )Tj 1 0 0 1 34.32001 166.73999 Tm (that are sent for destruction. Records are kept of medicines that are gi\ ven to people, )Tj 1 0 0 1 34.32001 149.23999 Tm (which helps to show that people receive their medicines as prescribed by\ the doctor. If )Tj 1 0 0 1 34.32001 131.75 Tm (a regularly prescribed dose is omitted, then a reason for this is record\ ed, as is good )Tj 1 0 0 1 34.32001 114.25 Tm (practice. Usually if a variable dose is prescribed there are clear recor\ ds to show how )Tj 1 0 0 1 34.32001 96.75 Tm (much is given, and this too is good practice.)Tj ET endstream endobj 915 0 obj 4862 endobj 916 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 686.21997 w 34.60001 468.30002 m 562.53998 468.30002 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 664.84998 w 33.47 456.47998 m 563.65997 456.47998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 121.86 l S 564.78998 791.10999 m 564.78998 121.86 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 122.93001 m 565.87 122.93001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We looked at some people's care plans to see what information is recorde\ d about their )Tj 1 0 0 1 34.32001 744.10999 Tm (medicines. We found written permission from the doctor to crush someone'\ s tablets )Tj 1 0 0 1 34.32001 726.60999 Tm (before giving. Staff had not asked if other forms of the same medicines \ are available, )Tj 1 0 0 1 34.32001 709.10999 Tm (such as soluble tablets or liquids, to make it easier for people to take\ . We found clear )Tj 1 0 0 1 34.32001 691.62 Tm (guidance for staff on when to administer medication that was prescribed \ to be given )Tj 1 0 0 1 34.32001 674.12 Tm ('when required'. This helps to show that people receive their medicines \ in the way )Tj 1 0 0 1 34.32001 656.63 Tm (their doctor intended for them.)Tj 1 0 0 1 34.32001 639.13 Tm (\240)Tj 1 0 0 1 34.32001 621.63 Tm (We looked at how people's privacy and dignity is maintained. We heard pe\ ople being )Tj 1 0 0 1 34.32001 604.14001 Tm (called by their preferred names and some people were able to tell us the\ y wear their )Tj 1 0 0 1 34.32001 586.64001 Tm (own clothes. We saw staff discreetly helping some people go to the toile\ t. However, )Tj 1 0 0 1 34.32001 569.14996 Tm (we also saw one person trying to attract the attention of staff who walk\ ed past or said )Tj 1 0 0 1 34.32001 551.64996 Tm ('hang on' as they walked past and did not come back. We heard one person\ saying no )Tj 1 0 0 1 34.32001 534.14996 Tm (repeatedly and we heard a carer saying 'yes, yes, yes' in a mocking fash\ ion.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We saw in the care plans of two people that they like to be or are washe\ d, shaved, )Tj 1 0 0 1 34.32001 481.66998 Tm (have their hair brushed and dressed whilst sitting on the commode. This \ is not a )Tj 1 0 0 1 34.32001 464.16998 Tm (dignified way to provide care. In addition a record of names of people w\ ho had taken )Tj 1 0 0 1 34.32001 446.66998 Tm (a bath is kept in the communal bathroom. This indicates an institutional\ approach to )Tj 1 0 0 1 34.32001 429.17999 Tm (people's personal care needs and to their confidentiality.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (We saw one person being hoisted to be taken to the toilet. When raised o\ ut of their )Tj 1 0 0 1 34.32001 376.69 Tm (seat there was a strong smell of urine. After they left the lounge, the \ smell persisted. )Tj 1 0 0 1 34.32001 359.19 Tm (We smelt the chair and found that the smell was coming from the fabric o\ f the chair, )Tj 1 0 0 1 34.32001 341.70001 Tm (and from the pressure relieving cushion on the chair. When staff returne\ d they put )Tj 1 0 0 1 34.32001 324.20001 Tm (this person back onto the chair. Each time this person shifted their wei\ ght in their )Tj 1 0 0 1 34.32001 306.70999 Tm (chair, there was an unpleasant odour of stale urine released.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj 1 0 0 1 34.32001 271.70999 Tm (We saw that two people share a bedroom. There are no records to show tha\ t each )Tj 1 0 0 1 34.32001 254.22 Tm (person has been consulted or made an informed choice about this, as shou\ ld happen. )Tj 1 0 0 1 34.32001 236.72 Tm (We saw that the room can be divided by a curtain. When we asked one pers\ on if this )Tj 1 0 0 1 34.32001 219.23 Tm (was used, they told us that it isn't always. Although this person says t\ hey don't mind, )Tj 1 0 0 1 34.32001 201.73 Tm (it is unclear what the other person sharing this room thinks or feels ab\ out this as they )Tj 1 0 0 1 34.32001 184.23 Tm (have communication difficulties.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (One health care professional commented that sometimes shared rooms creat\ e )Tj 1 0 0 1 34.32001 131.75 Tm (problems around privacy and dignity. )Tj ET endstream endobj 917 0 obj 5858 endobj 918 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 437.25 m 562.53998 437.25 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 119.35001 w 33.47 426 m 563.65997 426 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 364.12 l S 564.78998 487.87988 m 564.78998 364.12 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 365.20001 m 565.87 365.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Some people's quality of life is enhanced by continued links with their \ families and )Tj 1 0 0 1 36.62 409.25 Tm (friends and by the activities they take part in. However, not everyone i\ s having their )Tj 1 0 0 1 36.62 391.75998 Tm (individual social needs and rights to make choices met.)Tj 1 0 0 1 36.62 374.25998 Tm (People enjoy an appetising, balanced diet that meets their nutritional n\ eeds.)Tj 1 0 0 1 28.35001 349.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 257.30002 w 34.60001 210.67998 m 562.53998 210.67998 l S 1 1 1 RG 22.5 w 32.35001 330.32999 m 564.78998 330.32999 l S 235.92998 w 33.47 198.87 m 563.65997 198.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 317.95999 m 565.87 317.95999 l S 32.35001 319.03998 m 32.35001 78.70001 l S 564.78998 319.03998 m 564.78998 78.70001 l S 32.35001 317.95999 m 564.78998 317.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 327.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 302.26999 Tm (Since the last inspection the home has employed an activities co-ordinat\ or for 20 )Tj 1 0 0 1 36.57001 284.78 Tm (hours each week. This person is responsible for meeting the social needs\ of all the )Tj 1 0 0 1 36.57001 267.28 Tm (people living here and provides support with helping people to eat and w\ ith personal )Tj 1 0 0 1 36.57001 249.78998 Tm (care such as cutting people's nails.)Tj 1 0 0 1 36.57001 232.28998 Tm (\240)Tj 1 0 0 1 36.57001 214.78998 Tm (In surveys people told us there are usually activities they can take par\ t in if they want )Tj 1 0 0 1 36.57001 197.3 Tm (to. We saw that about 4 people who spend their time in the lounge are we\ ll attended )Tj 1 0 0 1 36.57001 179.8 Tm (to. We saw people took part in a picture quiz, in card games and in phys\ ical activity. )Tj 1 0 0 1 36.57001 162.31 Tm (These people were having fun, were being included, were relaxed and were\ treated )Tj 1 0 0 1 36.57001 144.81 Tm (with respect and with warmth. We saw that one person in particular is re\ ally )Tj 1 0 0 1 36.57001 127.31 Tm (benefiting from having this social interaction.)Tj 1 0 0 1 36.57001 109.82001 Tm (\240)Tj 1 0 0 1 36.57001 92.32001 Tm (We also saw the the lounge is laid out in such a way that separate areas\ have been )Tj ET endstream endobj 919 0 obj 4934 endobj 920 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (created. This means that people can take part in different activities or\ have )Tj 1 0 0 1 34.32001 761.60004 Tm (conversations without disturbing anyone else, and away from the televisi\ on. The )Tj 1 0 0 1 34.32001 744.10999 Tm (television was on throughout the day during this inspection. It was set \ to a very high )Tj 1 0 0 1 34.32001 726.60999 Tm (volume and no one was watching it. One person did take an interest when \ the )Tj 1 0 0 1 34.32001 709.10999 Tm (lunchtime news came on. They told us they like to hear the news, but tha\ t they're not )Tj 1 0 0 1 34.32001 691.62 Tm (bothered otherwise.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We saw one person enjoying knitting who also benefited from the activiti\ es organised. )Tj 1 0 0 1 34.32001 639.13 Tm (Other people were invited to join in and declined or were unable to do s\ o due to their )Tj 1 0 0 1 34.32001 621.63 Tm (disabilities.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (Other people living in this home spend time in their rooms. We spoke wit\ h staff about )Tj 1 0 0 1 34.32001 569.14996 Tm (how these people are supported to have their social needs met. We were t\ old the )Tj 1 0 0 1 34.32001 551.64996 Tm (activities co-ordinator spends time with these people in their rooms. We\ found that, )Tj 1 0 0 1 34.32001 534.14996 Tm (whilst well intentioned and very skillful, this person cannot meet the s\ ocial needs of all )Tj 1 0 0 1 34.32001 516.65997 Tm (the people living here. People who are physically or mentally disabled s\ pend long )Tj 1 0 0 1 34.32001 499.16 Tm (periods alone.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (One person told us they get bored lying in bed all day. Their relative s\ aid that staff )Tj 1 0 0 1 34.32001 446.66998 Tm (come into the room, but that this is to carry out care tasks such as tur\ ning. The care )Tj 1 0 0 1 34.32001 429.17999 Tm (plan for this person does not contain any information about their intere\ sts or religious )Tj 1 0 0 1 34.32001 411.67999 Tm (or spiritual needs.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Other care plans contain some information about people's interests. Howe\ ver, )Tj 1 0 0 1 34.32001 359.19 Tm (knowledge about these interests is not being used to meet each person's \ need to be )Tj 1 0 0 1 34.32001 341.70001 Tm (engaged and be social in an individualised way.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (For example each care plan has sections about people's spiritual needs. \ The care plan )Tj 1 0 0 1 34.32001 289.20999 Tm (of one person who has dementia states they are very religious and identi\ fies their )Tj 1 0 0 1 34.32001 271.70999 Tm (religion. The care plan section relating to social needs records that th\ is person loves to )Tj 1 0 0 1 34.32001 254.22 Tm (go out. The care plan does not identify how this person will be supporte\ d to attend a )Tj 1 0 0 1 34.32001 236.72 Tm (religious service or how they will be helped to go out. Staff tell us th\ is person does not )Tj 1 0 0 1 34.32001 219.23 Tm (go to church and does not go out. In addition, the part of the care plan\ relating to )Tj 1 0 0 1 34.32001 201.73 Tm (people's death and dying needs states that this person should be encoura\ ged to )Tj 1 0 0 1 34.32001 184.23 Tm (express their wishes regarding death as it approaches. This statement is\ used in all )Tj 1 0 0 1 34.32001 166.73999 Tm (the care plans we looked at where the section on death and dying had bee\ n )Tj 1 0 0 1 34.32001 149.23999 Tm (completed. This person's plan makes no mention of the arrangements this \ person )Tj 1 0 0 1 34.32001 131.75 Tm (might like in relation to their religion.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (Another person's care plan does not identify their social interests and \ we saw that this )Tj ET endstream endobj 921 0 obj 5000 endobj 922 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (person spent the day at the home in the lounge without being engaged in \ any activity.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We asked staff how decisions are made about who gets up early or late. S\ taff told us )Tj 1 0 0 1 34.32001 726.60999 Tm ('the diabetics are always got up first and that after that it depends on\ where the )Tj 1 0 0 1 34.32001 709.10999 Tm (member of staff decides to start work'. This indicates that people are n\ ot offered )Tj 1 0 0 1 34.32001 691.62 Tm (choice.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We found that the care plan for one person contains a recently written s\ tatement that )Tj 1 0 0 1 34.32001 639.13 Tm (they like to get up at 6am. It also states that the nurse writing this h\ as discussed this )Tj 1 0 0 1 34.32001 621.63 Tm (with the person and that they agree with this. This person is described \ in the care plan )Tj 1 0 0 1 34.32001 604.14001 Tm (as having dementia and being confused. We found this statement in the ca\ re plan of )Tj 1 0 0 1 34.32001 586.64001 Tm (another person who is also described as having dementia. This means that\ people who )Tj 1 0 0 1 34.32001 569.14996 Tm (cannot speak up for themselves do not make decisions and do not have con\ trol over )Tj 1 0 0 1 34.32001 551.64996 Tm (their individual daily lives.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj 1 0 0 1 34.32001 516.65997 Tm (Visitors told us they can visit when they like. And we saw visitors in t\ he home at )Tj 1 0 0 1 34.32001 499.16 Tm (different times of the day and evening. Some people say that staff keep \ them up to )Tj 1 0 0 1 34.32001 481.66998 Tm (date with changes and developments and others say that staff don't do th\ is.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (In surveys people told us they always like the food served in the home. \ People we )Tj 1 0 0 1 34.32001 429.17999 Tm (spoke with say they like the variety and the quality of food served. We \ heard staff )Tj 1 0 0 1 34.32001 411.67999 Tm (asking people what they would like for lunch, close to the time this was\ being served. )Tj 1 0 0 1 34.32001 394.19 Tm (This means that people are helped to make a choice about what to eat at \ a time when )Tj 1 0 0 1 34.32001 376.69 Tm (they are ready to make this decision and when it means something to them\ . We were )Tj 1 0 0 1 34.32001 359.19 Tm (unsure how staff helped people who cannot speak for themselves to make d\ ecisions )Tj 1 0 0 1 34.32001 341.70001 Tm (about what to eat. We asked a member of care staff who told us that they\ get to know )Tj 1 0 0 1 34.32001 324.20001 Tm (what people like. We saw in care plans that there are records about some\ people's )Tj 1 0 0 1 34.32001 306.70999 Tm (likes and dislikes, but not for all people. We saw records relating to w\ hat one person )Tj 1 0 0 1 34.32001 289.20999 Tm (eats. We saw that they have porridge for breakfast every day as far back\ as we saw )Tj 1 0 0 1 34.32001 271.70999 Tm (records for \(approximately 11 weeks\). They had also had scrambled egg \ for supper for )Tj 1 0 0 1 34.32001 254.22 Tm (the majority of those 11 weeks. Staff told us that this person sometimes\ does not eat )Tj 1 0 0 1 34.32001 236.72 Tm (much at supper and on the day of this inspection staff told us this pers\ on only ate 2 )Tj 1 0 0 1 34.32001 219.23 Tm (small spoonfuls of supper. The records and conversations with staff do n\ ot indicate )Tj 1 0 0 1 34.32001 201.73 Tm (that staff had explored the possibility that this person might be bored \ with their )Tj 1 0 0 1 34.32001 184.23 Tm (supper diet.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We heard that one person who spends all their time in their bedroom had \ not had )Tj 1 0 0 1 34.32001 131.75 Tm (breakfast on two occasions and that their morning tea had been missed a \ couple of )Tj 1 0 0 1 34.32001 114.25 Tm (times.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 923 0 obj 1224 endobj 924 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We also saw two people being supported to eat by staff whilst in their b\ edrooms. The )Tj 1 0 0 1 34.32001 761.60004 Tm (support given was unhurried, relaxed and sensitive. )Tj ET endstream endobj 925 0 obj 5679 endobj 926 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 505.73999 m 562.53998 505.73999 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 84.36 w 33.47 494.5 m 563.65997 494.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 450.12 l S 564.78998 538.88 m 564.78998 450.12 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 451.19 m 565.87 451.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People concerns are not always acted upon and people are not fully safeg\ uarded from )Tj 1 0 0 1 36.62 460.25 Tm (harm. )Tj 1 0 0 1 28.35001 435.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 343.30002 w 34.60001 253.67 m 562.53998 253.67 l S 1 1 1 RG 22.5 w 32.35001 416.31998 m 564.78998 416.31998 l S 321.92999 w 33.47 241.86 m 563.65997 241.86 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 403.94998 m 565.87 403.94998 l S 32.35001 405.03 m 32.35001 78.70001 l S 564.78998 405.03 m 564.78998 78.70001 l S 32.35001 403.94998 m 564.78998 403.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 413.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 388.26999 Tm (In surveys all 3 people told us that they know how to make a formal comp\ laint and 2 )Tj 1 0 0 1 36.57001 370.76999 Tm (told us there is someone they can speak with informally if they are not \ happy. One )Tj 1 0 0 1 36.57001 353.26999 Tm (person said they can only do this with their visitors.)Tj 1 0 0 1 36.57001 335.78 Tm (\240)Tj 1 0 0 1 36.57001 318.28 Tm (The information given to us in the AQAA tells us that this home has rece\ ived one )Tj 1 0 0 1 36.57001 300.78998 Tm (complaint since the last inspection a year ago. This was dealt with by t\ he home within )Tj 1 0 0 1 36.57001 283.29001 Tm (28 days, which is the timescale set, and it was upheld. It also tells us\ that one )Tj 1 0 0 1 36.57001 265.79001 Tm (safeguarding alert was made alleging that someone living at the home was\ not )Tj 1 0 0 1 36.57001 248.3 Tm (receiving care that was safe. This was investigated by the safeguarding \ team in May )Tj 1 0 0 1 36.57001 230.8 Tm (2009. The outcome of this was that the care provided was not neglectful \ or abusive, )Tj 1 0 0 1 36.57001 213.31 Tm (but was poor practice.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Since then the commission has received two complaints about the quality \ of care, )Tj 1 0 0 1 36.57001 160.81999 Tm (about staff not being available when needed, about the management of med\ icines and )Tj 1 0 0 1 36.57001 143.31999 Tm (about the general management of the home. One person said they had bough\ t their )Tj 1 0 0 1 36.57001 125.83 Tm (concerns to the attention of staff but did not get a satisfactory respon\ se. Another )Tj 1 0 0 1 36.57001 108.33 Tm (person said they thought that staff were not taking their concerns serio\ usly enough.)Tj 1 0 0 1 36.57001 90.83 Tm (\240)Tj ET endstream endobj 927 0 obj 5335 endobj 928 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We have looked at some of these issues during this inspection and are wo\ rking with )Tj 1 0 0 1 34.32001 761.60004 Tm (the safeguarding team who are undertaking an investigation relating to t\ hese )Tj 1 0 0 1 34.32001 744.10999 Tm (allegations. In addition Devon County Council are reviewing the care of \ the people )Tj 1 0 0 1 34.32001 726.60999 Tm (living here.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (The AQAA tells us that no one living here is subject to any form of rest\ raint. However, )Tj 1 0 0 1 34.32001 674.12 Tm (a referral was made under the Deprivation of Liberty and Mental Capacity\ Act because )Tj 1 0 0 1 34.32001 656.63 Tm (one person is being restrained in their wheelchair. This is not a depriv\ ation of liberty )Tj 1 0 0 1 34.32001 639.13 Tm (but is a form of restraint. We saw that this continues. We also saw in a\ care plan that )Tj 1 0 0 1 34.32001 621.63 Tm (another person is restrained in their chair by using a lap belt when the\ y try to stand )Tj 1 0 0 1 34.32001 604.14001 Tm (up. We saw that people have bed rails whilst in their beds, which is ano\ ther form of )Tj 1 0 0 1 34.32001 586.64001 Tm (restraint. There is some indication that the restraint used for people w\ hilst sitting in )Tj 1 0 0 1 34.32001 569.14996 Tm (their chairs might not always be appropriate. This is because records st\ ate that it is )Tj 1 0 0 1 34.32001 551.64996 Tm (used when people try to stand up or get agitated. The use of restraint i\ s sometimes )Tj 1 0 0 1 34.32001 534.14996 Tm (the only action that can be taken to keep someone safe. However, records\ should )Tj 1 0 0 1 34.32001 516.65997 Tm (show that all other actions to reduce risk have been tried before this a\ ction is taken. )Tj 1 0 0 1 34.32001 499.16 Tm (In addition, care plans do not give clear and specific instructions as t\ o when restraint )Tj 1 0 0 1 34.32001 481.66998 Tm (should be used and for how long. We asked staff about the use of restrai\ nt in the form )Tj 1 0 0 1 34.32001 464.16998 Tm (of a lap belt for one person. They told us that they use it only when ne\ eded, when )Tj 1 0 0 1 34.32001 446.66998 Tm (staff are not around, and for a few hours. This means that restraint is \ being used for )Tj 1 0 0 1 34.32001 429.17999 Tm (long periods when staff are not around to supervise vulnerable and agita\ ted people.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (People who live here are having decisions about forms of restraint made \ by staff or )Tj 1 0 0 1 34.32001 376.69 Tm (relatives. Sometimes this has to happen if the person involved is not ab\ le to make )Tj 1 0 0 1 34.32001 359.19 Tm (these decisions for themselves. The circumstances of these decisions sho\ uld be )Tj 1 0 0 1 34.32001 341.70001 Tm (recorded so that it is clear that these decisions are being made in the \ best interests of )Tj 1 0 0 1 34.32001 324.20001 Tm (that person. Such records are not being kept for people living in this h\ ome.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We saw three people who have bruises or broken skin. We asked staff abou\ t these. )Tj 1 0 0 1 34.32001 271.70999 Tm (They gave us explanations for two but staff did not know what had caused\ the third )Tj 1 0 0 1 34.32001 254.22 Tm (injury. We saw in care records that one person's injury had been caused \ when they )Tj 1 0 0 1 34.32001 236.72 Tm (had resisted care. The circumstances of this have not been investigated \ and actions )Tj 1 0 0 1 34.32001 219.23 Tm (have not been taken to prevent this happening again. Another person inju\ red them )Tj 1 0 0 1 34.32001 201.73 Tm (self on a bed rail and there are no records to show that actions have be\ en taken to )Tj 1 0 0 1 34.32001 184.23 Tm (prevent this happening again.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We spoke with staff about what they would do if they saw or suspected ab\ use. They )Tj 1 0 0 1 34.32001 131.75 Tm (told us they would tell the nurse in charge, as is good practice. We ask\ ed the nurse in )Tj 1 0 0 1 34.32001 114.25 Tm (charge what they would do, and the actions they describe are contrary to\ the guidance )Tj 1 0 0 1 34.32001 96.75 Tm (given in the multi-agency guidance. This person told us that they had re\ ceived )Tj ET endstream endobj 929 0 obj 1252 endobj 930 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (training and had a copy of the guidance in the home. However, the guidan\ ce they )Tj 1 0 0 1 34.32001 761.60004 Tm (showed us would not guide them to take appropriate action if abuse were \ suspected. )Tj ET endstream endobj 931 0 obj 5720 endobj 932 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 488.73999 m 562.53998 488.73999 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 84.36 w 33.47 477.5 m 563.65997 477.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 433.12 l S 564.78998 521.88 m 564.78998 433.12 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 434.19 m 565.87 434.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (People living here enjoy a homely environment. However, improvements are\ needed )Tj 1 0 0 1 36.62 443.25 Tm (to ensure that people are fully protected from infection. )Tj 1 0 0 1 28.35001 418.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 326.30002 w 34.60001 245.17 m 562.53998 245.17 l S 1 1 1 RG 22.5 w 32.35001 399.31998 m 564.78998 399.31998 l S 304.92999 w 33.47 233.36 m 563.65997 233.36 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 386.94998 m 565.87 386.94998 l S 32.35001 388.03 m 32.35001 78.70001 l S 564.78998 388.03 m 564.78998 78.70001 l S 32.35001 386.94998 m 564.78998 386.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 396.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 371.26999 Tm (In surveys people told us that the home is usually clean and fresh. On t\ he day we )Tj 1 0 0 1 36.57001 353.76999 Tm (visited we found it to be clean and odour free.)Tj 1 0 0 1 36.57001 336.26999 Tm (\240)Tj 1 0 0 1 36.57001 318.78 Tm (The home is warm, and is furnished and decorated in a domestic and homel\ y style. )Tj 1 0 0 1 36.57001 301.28 Tm (There is a reception area in the large hall, where there is usually a me\ mber of staff )Tj 1 0 0 1 36.57001 283.79001 Tm (during the day so that people visiting the home can speak with them. The\ re is also a )Tj 1 0 0 1 36.57001 266.29001 Tm (large board in the hall displaying the photographs and names of the staf\ f working at )Tj 1 0 0 1 36.57001 248.78998 Tm (the home. This is helpful so that people can identify and become familia\ r with staff.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The home has one large lounge and a dining room. Both are decorated and \ furnished )Tj 1 0 0 1 36.57001 196.31 Tm (in a homely style. The tables in the dining room are smaller and this he\ lps people to )Tj 1 0 0 1 36.57001 178.81 Tm (sit in smaller groups and to experience meals as a social occasion. The \ lounge is )Tj 1 0 0 1 36.57001 161.31 Tm (divided into smaller seating areas so that people can carry out differen\ t activities )Tj 1 0 0 1 36.57001 143.81999 Tm (without disturbing others. This area is very bright as it has large wind\ ows to the side )Tj 1 0 0 1 36.57001 126.32001 Tm (and rear of the house.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (We saw staff washing their hands and wearing protective clothing as a wa\ y of helping )Tj ET endstream endobj 933 0 obj 2517 endobj 934 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (to prevent the spread of infection. Staff use alcohol gel as another way\ of preventing )Tj 1 0 0 1 34.32001 761.60004 Tm (the spread of infection, and this is also available for visitors to the \ home to use.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we saw that the sluice did not have liquid soap for staff to wa\ sh their hands, )Tj 1 0 0 1 34.32001 709.10999 Tm (and that some soap dispensers appear dirty and one was empty.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last inspection by the commission the home have also been visi\ ted by the )Tj 1 0 0 1 34.32001 656.63 Tm (fire authority. Some actions were required and these have been carried o\ ut. We saw )Tj 1 0 0 1 34.32001 639.13 Tm (that access from the home is controlled at the front door by a key pad s\ ystem and )Tj 1 0 0 1 34.32001 621.63 Tm (were told that this is linked to the fire alarm. This means that when th\ e fire alarm )Tj 1 0 0 1 34.32001 604.14001 Tm (sounds that the door lock will automatically be opened, and is good prac\ tice.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We were told that some areas of the home have been redecorated. We saw o\ ne )Tj 1 0 0 1 34.32001 551.64996 Tm (upstairs window being replaced. We saw that staff test and record the te\ mperature of )Tj 1 0 0 1 34.32001 534.14996 Tm (bathing water as is good practice to ensure that accidental scalding is \ prevented. )Tj ET endstream endobj 935 0 obj 5784 endobj 936 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 480 m 562.53998 480 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 101.85001 w 33.47 468.75 m 563.65997 468.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 415.62 l S 564.78998 521.88 m 564.78998 415.62 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 416.70001 m 565.87 416.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (There are not always enough staff on duty with the appropriate qualifica\ tions, training )Tj 1 0 0 1 36.62 443.25 Tm (and skills to care for people living here. Practices in relation to recr\ uitment are placing )Tj 1 0 0 1 36.62 425.75998 Tm (people at risk of harm. )Tj 1 0 0 1 28.35001 401.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 308.80002 w 34.60001 236.42998 m 562.53998 236.42998 l S 1 1 1 RG 22.5 w 32.35001 381.82999 m 564.78998 381.82999 l S 287.42999 w 33.47 224.62 m 563.65997 224.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 369.44998 m 565.87 369.44998 l S 32.35001 370.53 m 32.35001 78.70001 l S 564.78998 370.53 m 564.78998 78.70001 l S 32.35001 369.44998 m 564.78998 369.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 378.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 353.76999 Tm (This is a nursing home and should have a registered nurse on duty throug\ hout the day )Tj 1 0 0 1 36.57001 336.26999 Tm (and night. We were contacted by a person who was concerned this was not \ )Tj 1 0 0 1 36.57001 318.78 Tm (happening. We contacted the home and it was confirmed that on one night \ there was )Tj 1 0 0 1 36.57001 301.28 Tm (not a nurse on duty. We asked the owner why they had not used an agency \ nurse to )Tj 1 0 0 1 36.57001 283.79001 Tm (cover this shift. They told us that this home never uses agency staff. T\ hey told us that )Tj 1 0 0 1 36.57001 266.29001 Tm (due to staff sickness they had arranged for a nurse to sleep at the home\ on that night. )Tj 1 0 0 1 36.57001 248.78998 Tm (This practice puts people at risk.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The caller was also concerned that there are not enough staff on duty. W\ e spoke to )Tj 1 0 0 1 36.57001 196.31 Tm (the owner about this. She told us that staffing has been reduced but tha\ t there are )Tj 1 0 0 1 36.57001 178.81 Tm (enough staff on duty to meet people's current needs. We looked at the du\ ty rota and )Tj 1 0 0 1 36.57001 161.31 Tm (saw that there had previously been 3 or 4 carers on duty in the morning \ and this had )Tj 1 0 0 1 36.57001 143.81999 Tm (been reduced to 2 or 3 carers. In the afternoon we saw that there used t\ o be 2 or 3 )Tj 1 0 0 1 36.57001 126.32001 Tm (carers on duty in the afternoon, and now there are 2. On the day of this\ inspection )Tj 1 0 0 1 36.57001 108.83 Tm (there was a nurse on duty with 3 carers, an administrator, cook and the \ temporary )Tj 1 0 0 1 36.57001 91.33 Tm (manager.)Tj ET endstream endobj 937 0 obj 4923 endobj 938 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We saw in the information given to us by the home prior to the inspectio\ n that there )Tj 1 0 0 1 34.32001 744.10999 Tm (are 14 people living at the home who need help with undressing and dress\ ing, and )Tj 1 0 0 1 34.32001 726.60999 Tm (need help to go to the toilet. 11 people are incontinent of both faeces \ and urine and 8 )Tj 1 0 0 1 34.32001 709.10999 Tm (people have dementia. 11 people need two members of staff to help them w\ ith their )Tj 1 0 0 1 34.32001 691.62 Tm (care.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (In surveys one person told us that staff are usually available, one that\ staff are )Tj 1 0 0 1 34.32001 639.13 Tm (sometimes available and one that staff are never available when needed. \ Comments )Tj 1 0 0 1 34.32001 621.63 Tm (included staff are not always available, and the home is very short of s\ taff. The )Tj 1 0 0 1 34.32001 604.14001 Tm (surveys also asked what the home could do better. People said employ mor\ e staff who )Tj 1 0 0 1 34.32001 586.64001 Tm (can speak and understand English and train and employ more staff especia\ lly at night. )Tj 1 0 0 1 34.32001 569.14996 Tm (Staff were however described as nice and lovely.)Tj 1 0 0 1 34.32001 551.64996 Tm (\240)Tj 1 0 0 1 34.32001 534.14996 Tm (We looked at the records relating to falls and injuries. According to th\ ese records )Tj 1 0 0 1 34.32001 516.65997 Tm (people have been found to have fallen when there have been no staff pres\ ent on 14 )Tj 1 0 0 1 34.32001 499.16 Tm (separate occasions since the beginning of July this year. This means tha\ t people are )Tj 1 0 0 1 34.32001 481.66998 Tm (not being sufficiently supervised by staff to keep them safe.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We know that these accident records are incomplete. We are aware that on\ e person )Tj 1 0 0 1 34.32001 429.17999 Tm (has fallen whilst alone, and this is not recorded. We also saw that two \ people had )Tj 1 0 0 1 34.32001 411.67999 Tm (injuries which have not been recorded as accidents or incidents.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We looked at the duty rota and found that is is not always accurate. For\ example, on )Tj 1 0 0 1 34.32001 359.19 Tm (some weeks the manager, who has left the home, is recorded as on duty. I\ n addition, )Tj 1 0 0 1 34.32001 341.70001 Tm (the temporary manager has not been included on the duty rota until Septe\ mber )Tj 1 0 0 1 34.32001 324.20001 Tm (although they say they started work at the home in August.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We asked to see the records of staff training. We were told that these a\ re incomplete )Tj 1 0 0 1 34.32001 271.70999 Tm (because the records about training have gone missing since the manager l\ eft the )Tj 1 0 0 1 34.32001 254.22 Tm (home. We saw that some records had been made about training, but that th\ ere were )Tj 1 0 0 1 34.32001 236.72 Tm (large gaps. The management team tell us that this means they are not ful\ ly aware of )Tj 1 0 0 1 34.32001 219.23 Tm (what training staff have had, and what training might be needed. We did \ see a notice )Tj 1 0 0 1 34.32001 201.73 Tm (that said that training has been arranged for staff in relation preventi\ ng people from )Tj 1 0 0 1 34.32001 184.23 Tm (falling.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (Staff told us they had had some training. One told us they had had train\ ing in how to )Tj 1 0 0 1 34.32001 131.75 Tm (provide care to people, another that they thought they had had training \ in relation to )Tj 1 0 0 1 34.32001 114.25 Tm (supporting people who have problems with swallowing. However, they went \ on to )Tj 1 0 0 1 34.32001 96.75 Tm (describe training which relates to nutritional supplements. One person t\ hought they )Tj ET endstream endobj 939 0 obj 2380 endobj 940 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 266.32001 w 34.60001 678.25 m 562.53998 678.25 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 244.93999 w 33.47 666.44 m 563.65997 666.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 541.76001 l S 564.78998 791.10999 m 564.78998 541.76001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 542.83997 m 565.87 542.83997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (had had training about dementia, and gave a description of how to care f\ or someone )Tj 1 0 0 1 34.32001 761.60004 Tm (with dementia which was an example of good practice.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we also saw that staff record that people have drunk more than \ they have. )Tj 1 0 0 1 34.32001 709.10999 Tm (We heard staff trying to persuade a confused person that their understan\ ding of a )Tj 1 0 0 1 34.32001 691.62 Tm (situation was wrong, causing distress and confusion to this person. We a\ lso saw staff )Tj 1 0 0 1 34.32001 674.12 Tm (ignoring one person who was trying to attract their attention.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (The AQAA told us that 10 of the 12 carers working at this home have achi\ eved a )Tj 1 0 0 1 34.32001 621.63 Tm (National Vocational Qualification \(NVQ\) in care, to level 2 or above. \ We asked the )Tj 1 0 0 1 34.32001 604.14001 Tm (manager if there is a system in place to ensure that staff practice the \ skills they are )Tj 1 0 0 1 34.32001 586.64001 Tm (taught, and to ensure they do this to the level of quality that is expec\ ted. The )Tj 1 0 0 1 34.32001 569.14996 Tm (manager told us that this is the nurses responsibility and that there is\ no formal )Tj 1 0 0 1 34.32001 551.64996 Tm (system.)Tj ET endstream endobj 941 0 obj 5831 endobj 942 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 395 m 562.53998 395 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 101.85001 w 33.47 383.75 m 563.65997 383.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 330.62 l S 564.78998 436.88 m 564.78998 330.62 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 331.70001 m 565.87 331.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of leadership in this home means that systems are not in place to e\ nsure that )Tj 1 0 0 1 36.62 358.25 Tm (people receive the care they need to an acceptable standard in a way tha\ t promotes )Tj 1 0 0 1 36.62 340.75998 Tm (their safety. )Tj 1 0 0 1 28.35001 316.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.8 w 34.60001 193.92999 m 562.53998 193.92999 l S 1 1 1 RG 22.5 w 32.35001 296.82999 m 564.78998 296.82999 l S 202.42998 w 33.47 182.12 m 563.65997 182.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 284.44998 m 565.87 284.44998 l S 32.35001 285.53 m 32.35001 78.70001 l S 564.78998 285.53 m 564.78998 78.70001 l S 32.35001 284.44998 m 564.78998 284.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.76999 Tm (This home does not have a Registered Manager. The previous manager left \ in August )Tj 1 0 0 1 36.57001 251.26999 Tm (2009. Since that time the home has been managed on a temporary basis. Th\ e )Tj 1 0 0 1 36.57001 233.78 Tm (temporary manager is a Registered Nurse and is studying for a Leadership\ and )Tj 1 0 0 1 36.57001 216.28 Tm (Management qualification. She had been working as the \(unregistered\) m\ anager of )Tj 1 0 0 1 36.57001 198.78998 Tm (the owners' residential home, and works from 9am - 3pm four days weekly.\ She is )Tj 1 0 0 1 36.57001 181.28998 Tm (supernumerary to nursing hours and is supported by two of the four owner\ s of this )Tj 1 0 0 1 36.57001 163.78999 Tm (home, who are also nurses.)Tj 1 0 0 1 36.57001 146.3 Tm (\240)Tj 1 0 0 1 36.57001 128.8 Tm (In the last few months the commission has received comments from relativ\ es of )Tj 1 0 0 1 36.57001 111.31 Tm (people living here who say the overall management of the home has declin\ ed. One )Tj 1 0 0 1 36.57001 93.81 Tm (person described the management as chaotic, saying that this has resulte\ d in people )Tj ET endstream endobj 943 0 obj 5070 endobj 944 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (not getting the care they need.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked to see if there are systems in place to ensure the home runs e\ fficiently and )Tj 1 0 0 1 34.32001 726.60999 Tm (safely, and that people get the care they need. We found that systems ar\ e not robust )Tj 1 0 0 1 34.32001 709.10999 Tm (enough to achieve this.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (For example we looked at the system for communicating peoples' needs and\ changing )Tj 1 0 0 1 34.32001 656.63 Tm (needs, and for ensuring that peoples' needs are met. The owners and mana\ ger told us )Tj 1 0 0 1 34.32001 639.13 Tm (that this is achieved through the care planning system. However, we foun\ d that these )Tj 1 0 0 1 34.32001 621.63 Tm (documents are complex and contradictory in places. They do not always pr\ ovide the )Tj 1 0 0 1 34.32001 604.14001 Tm (level of detail needed by staff to ensure that they have the information\ they need, and )Tj 1 0 0 1 34.32001 586.64001 Tm (to ensure that people's needs are met in a way that is consistent and of\ a satisfactory )Tj 1 0 0 1 34.32001 569.14996 Tm (quality. We found that reviews of people's care do not include all the i\ nformation )Tj 1 0 0 1 34.32001 551.64996 Tm (available and do not always provide evidence for some of the care decisi\ ons made )Tj 1 0 0 1 34.32001 534.14996 Tm (\(see Health and Personal Care\). Care staff told us they do not read ca\ re plans. We )Tj 1 0 0 1 34.32001 516.65997 Tm (asked if they got a hand over of information at the beginning of each sh\ ift and they )Tj 1 0 0 1 34.32001 499.16 Tm (told us they do not. We asked the manager how information is relayed to \ staff. She )Tj 1 0 0 1 34.32001 481.66998 Tm (told us that she expects the nurses to do this. The evidence in the Heal\ th and Personal )Tj 1 0 0 1 34.32001 464.16998 Tm (Care section of this report, shows that this is not happening.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked closely at how some decisions about people's care are made. Fo\ r example, )Tj 1 0 0 1 34.32001 411.67999 Tm (one record states that one person cannot make a decision about having be\ d rails on )Tj 1 0 0 1 34.32001 394.19 Tm (their bed. However, records show that this person has made a decision ab\ out having )Tj 1 0 0 1 34.32001 376.69 Tm (repeated invasive procedures. Another person can make the decision to ge\ t up at 6am )Tj 1 0 0 1 34.32001 359.19 Tm (but cannot make a decision about what they eat.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at how risks in the home are managed. We found that people are\ identified )Tj 1 0 0 1 34.32001 306.70999 Tm (as being at risk of falling. Care records instruct staff to observe them\ . Records show )Tj 1 0 0 1 34.32001 289.20999 Tm (that a lot of falls have happened to people when staff are not present. \ Although there )Tj 1 0 0 1 34.32001 271.70999 Tm (is a system for recording this information, there is not a system for mo\ nitoring and )Tj 1 0 0 1 34.32001 254.22 Tm (analysing this information, and therefore actions have not been taken to\ help prevent )Tj 1 0 0 1 34.32001 236.72 Tm (and reduce the number of falls.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (We looked to see if there is a safe system in place for moving and handl\ ing people )Tj 1 0 0 1 34.32001 184.23 Tm (with mobility problems. We found that assessments have not been carried \ out or had )Tj 1 0 0 1 34.32001 166.73999 Tm (been carried out a long time ago and have not been reviewed. We found th\ at decisions )Tj 1 0 0 1 34.32001 149.23999 Tm (about the type of equipment to be used are based on the equipment that i\ s available )Tj 1 0 0 1 34.32001 131.75 Tm (and not on what would be the most suitable for each person. The manager \ reports )Tj 1 0 0 1 34.32001 114.25 Tm (that staff have not had training in how to carry out moving and handling\ assessments.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 945 0 obj 5058 endobj 946 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We looked at how other risks in the home have been managed. We found tha\ t the )Tj 1 0 0 1 34.32001 761.60004 Tm (temperature of hot water is restricted to help ensure that people are no\ t scalded. We )Tj 1 0 0 1 34.32001 744.10999 Tm (found that windows have restricted openings to prevent people falling. H\ owever, we )Tj 1 0 0 1 34.32001 726.60999 Tm (found one window, that had been replaced that day, did not have a restri\ cted opening. )Tj 1 0 0 1 34.32001 709.10999 Tm (We told one of the owners who told us they thought that it had been rest\ ricted since )Tj 1 0 0 1 34.32001 691.62 Tm (we last looked. When we looked again, it had not.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked in the kitchen and found it clean and tidy. The owners identif\ ied )Tj 1 0 0 1 34.32001 639.13 Tm (approximately 4 years ago that the kitchen is coming to the end of its u\ seful life, and )Tj 1 0 0 1 34.32001 621.63 Tm (the Environmental Health Officer also identified this. The cook reports \ that a )Tj 1 0 0 1 34.32001 604.14001 Tm (refurbishment date has not yet been set.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We looked at how equipment is maintained. We found that the weighing sca\ les had )Tj 1 0 0 1 34.32001 551.64996 Tm (been weighing inaccurately for some time meaning that people at risk of \ malnutrition )Tj 1 0 0 1 34.32001 534.14996 Tm (could not be weighed accurately. The lift broke down for at least 2 days\ in October.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We looked at how the home involve people in the running of the home and \ how the )Tj 1 0 0 1 34.32001 481.66998 Tm (management team get feedback from people and improve the quality of care\ given. )Tj 1 0 0 1 34.32001 464.16998 Tm (We were told by relatives that meetings are sometimes held to which they\ are invited. )Tj 1 0 0 1 34.32001 446.66998 Tm (One person told us at that at the last meeting they had been informed th\ ere were )Tj 1 0 0 1 34.32001 429.17999 Tm (going to be a lot of changes in the home. They asked for, and the manage\ ment team )Tj 1 0 0 1 34.32001 411.67999 Tm (agreed they could have, a list of these changes so that they could prepa\ re their parent )Tj 1 0 0 1 34.32001 394.19 Tm (for these changes. They have not received this.)Tj 1 0 0 1 34.32001 376.69 Tm (\240)Tj 1 0 0 1 34.32001 359.19 Tm (We looked at the results of the most recent quality assurance survey \(J\ une 2009\). )Tj 1 0 0 1 34.32001 341.70001 Tm (Some people had said they were not satisfied with the length of time it \ took to answer )Tj 1 0 0 1 34.32001 324.20001 Tm (call bells. One person said that new staff were not given enough trainin\ g meaning that )Tj 1 0 0 1 34.32001 306.70999 Tm (they had to take instruction from the person they were meant to be carin\ g for. Two )Tj 1 0 0 1 34.32001 289.20999 Tm (people thought that improvements should be made to laundry and one to ir\ oning. We )Tj 1 0 0 1 34.32001 271.70999 Tm (asked how these issues had been addressed and the owner did not know bec\ ause the )Tj 1 0 0 1 34.32001 254.22 Tm (survey was carried out when the previous manager was employed.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We checked to see if previous requirements set by the commission have be\ en met. )Tj 1 0 0 1 34.32001 201.73 Tm (We found that requirements relating to health and welfare, care planning\ , )Tj 1 0 0 1 34.32001 184.23 Tm (safeguarding people, meeting people's social needs, staff skills and imp\ roving the )Tj 1 0 0 1 34.32001 166.73999 Tm (overall management have not been met.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We did not check any personal allowance accounts of the people living he\ re as the )Tj 1 0 0 1 34.32001 114.25 Tm (home does not hold any money on behalf of people. Instead they run a deb\ it account, )Tj 1 0 0 1 34.32001 96.75 Tm (recording all monies spent on people's behalf. Records and receipts are \ given to )Tj ET endstream endobj 947 0 obj 1648 endobj 948 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (35)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 126.35001 w 34.60001 748.22998 m 562.53998 748.22998 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 104.98 w 33.47 736.41998 m 563.65997 736.41998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 681.72998 l S 564.78998 791.10999 m 564.78998 681.72998 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 682.81 m 565.87 682.81 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (relatives and supporters for them to check and to pay for retrospectivel\ y.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (During our inspection it came to light that the commission are not being\ notified of all )Tj 1 0 0 1 34.32001 726.60999 Tm (incidents that affect the welfare of people living here as they should b\ e. 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They )Tj 1 0 0 1 294.54999 448.95999 Tm (must record their findings )Tj 1 0 0 1 294.54999 434.38 Tm (and send these to the )Tj 1 0 0 1 294.54999 419.80002 Tm (commission after each visit.)Tj 1 0 0 1 294.54999 405.22 Tm (\240)Tj 1 0 0 1 294.54999 390.63998 Tm (Previous timescale of )Tj 1 0 0 1 294.54999 376.06 Tm (13/04/07 not met.)Tj 1 0 0 1 294.54999 361.47998 Tm (\240)Tj 1 0 0 1 294.54999 346.89999 Tm (Not inspected on this )Tj 1 0 0 1 294.54999 332.32001 Tm (occasion. 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This )Tj 1 0 0 1 298.04999 446.73999 Tm (assessment must include )Tj 1 0 0 1 298.04999 429.73999 Tm (health and social care )Tj 1 0 0 1 298.04999 412.73999 Tm (assessments if the )Tj 1 0 0 1 298.04999 395.73999 Tm (placement takes place )Tj 1 0 0 1 298.04999 378.73999 Tm (through health or social care )Tj 1 0 0 1 298.04999 361.73999 Tm (services. )Tj 1 0 0 1 298.04999 344.73999 Tm (\240)Tj 1 0 0 1 298.04999 327.73999 Tm (This will help to ensure that )Tj 1 0 0 1 298.04999 310.73999 Tm (each person's needs are )Tj 1 0 0 1 298.04999 293.73999 Tm (identified and can be met. )Tj 1 0 0 1 482.10001 514.73999 Tm (07/12/2009)Tj 1 0 0 1 554.04999 514.73999 Tm (\240)Tj 1 0 0 1 35.5 274.48999 Tm (2)Tj 1 0 0 1 99.3 274.48999 Tm (7)Tj 1 0 0 1 201.55 274.48999 Tm (15)Tj 1 0 0 1 298.04999 274.48999 Tm (You must ensure that care )Tj 1 0 0 1 298.04999 257.48999 Tm (plans provide clear and up )Tj 1 0 0 1 298.04999 240.48999 Tm (to date instructions on how )Tj 1 0 0 1 298.04999 223.48999 Tm (each person's care needs )Tj 1 0 0 1 298.04999 206.48999 Tm (are to be met, recorded and )Tj 1 0 0 1 298.04999 189.48999 Tm (monitored. Information )Tj 1 0 0 1 298.04999 172.48999 Tm (recorded in care plans must )Tj 1 0 0 1 298.04999 155.48999 Tm (be relevant and appropriate. )Tj 1 0 0 1 298.04999 138.48999 Tm (All parts of the care plan )Tj 1 0 0 1 298.04999 121.49001 Tm (must be reviewed and )Tj 1 0 0 1 298.04999 104.49001 Tm (updated as appropriate. All )Tj 1 0 0 1 298.04999 87.49001 Tm (irrelevant parts of the care )Tj 1 0 0 1 298.04999 70.49001 Tm (plan must be removed. )Tj 1 0 0 1 482.10001 274.48999 Tm (07/12/2009)Tj 1 0 0 1 554.04999 274.48999 Tm (\240)Tj ET endstream endobj 957 0 obj 5324 endobj 958 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (40)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj ET 0.95294 0.95294 0.95294 RG 732.78998 w 32.32001 445.00998 m 564.96997 445.00998 l S 1 1 1 RG 102 w 31.2 659.98999 m 91.05 659.98999 l S 93.3 659.98999 m 197.40001 659.98999 l S 199.64998 659.98999 m 289.44998 659.98999 l S 291.70001 659.98999 m 473.80002 659.98999 l S 476.04999 659.98999 m 566.10004 659.98999 l S 374 w 31.2 419.73999 m 91.05 419.73999 l S 93.3 419.73999 m 197.40001 419.73999 l S 199.64998 419.73999 m 289.44998 419.73999 l S 291.70001 419.73999 m 473.80002 419.73999 l S 476.04999 419.73999 m 566.10004 419.73999 l S 153 w 31.2 153.98999 m 91.05 153.98999 l S 93.3 153.98999 m 197.40001 153.98999 l S 199.64998 153.98999 m 289.44998 153.98999 l S 291.70001 153.98999 m 473.80002 153.98999 l S 476.04999 153.98999 m 566.10004 153.98999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 607.85999 m 568.29999 607.85999 l S 28.99001 231.61 m 568.29999 231.61 l S 30.07001 713.19 m 30.07001 75.29001 l S 567.21997 713.19 m 567.21997 75.29001 l S 28.99001 744.65997 m 568.40002 744.65997 l S 28.99001 712.10999 m 568.29999 712.10999 l S 92.17 713.19 m 92.17 75.29001 l S 198.51999 713.19 m 198.51999 75.29001 l S 290.57001 713.19 m 290.57001 75.29001 l S 474.91998 713.19 m 474.91998 75.29001 l S 28.99001 813.64996 m 568.40002 813.64996 l S 28.99001 744.65997 m 568.40002 744.65997 l S 28.99001 712.10999 m 568.40002 712.10999 l S 28.99001 607.85999 m 568.29999 607.85999 l S 28.99001 231.61 m 568.29999 231.61 l S 28.99001 76.36 m 568.29999 76.36 l S 30.07001 814.72998 m 30.07001 711.03998 l S 92.12 745.73999 m 92.12 711.03998 l S 198.51999 745.73999 m 198.51999 711.03998 l S 290.62 745.73999 m 290.62 711.03998 l S 475.01999 745.73999 m 475.01999 711.03998 l S 567.32001 814.72998 m 567.32001 711.03998 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 800.46997 Tm (Statutory requirements)Tj 0 Tr 1 0 0 1 34.05 780.46997 Tm (These requirements set out what the registered person must do to meet th\ e Care )Tj 1 0 0 1 34.05 765.88995 Tm (Standards Act 2000, Care Homes)Tj 1 0 0 1 239.76999 765.88995 Tm (Regulations 2001 and the National Minimum )Tj 1 0 0 1 34.05 751.31 Tm (Standards. 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239.06998 Tm (4)Tj 1 0 0 1 96.15001 239.06998 Tm (30)Tj 1 0 0 1 202.5 239.06998 Tm (You must ensure that staff have had the training they need )Tj 1 0 0 1 202.5 224.48999 Tm (to care for people appropriately.)Tj ET endstream endobj 969 0 obj 1872 endobj 970 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (46)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 22.5 w 22.95 802.40997 m 560.45001 802.40997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 28.35001 799.08997 Tm (Helpline:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 28.35001 781.10999 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 28.35001 759.60004 Tm (Telephone:)Tj 0 Tr 1 0 0 1 95.88 759.60004 Tm ( 03000 616161)Tj 2 Tr 1 0 0 1 28.35001 739.60004 Tm (Email:)Tj 0 Tr 1 0 0 1 66.84 739.60004 Tm ( enquiries@cqc.org.uk)Tj 2 Tr 1 0 0 1 28.35001 719.60999 Tm (Web:)Tj 0 Tr 1 0 0 1 64.35001 719.60999 Tm (www.cqc.org.uk)Tj 1 0 0 1 28.35001 699.60999 Tm (\240)Tj 1 0 0 1 28.35001 679.60999 Tm (We want people to be able to access this information. If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 971 0 obj 4539 endobj 972 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 73.32001 w 31.2 470.10999 m 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for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 975 0 obj 5469 endobj 976 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 977 0 obj 9099 endobj 978 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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534.54999 281.29001 l S 536.79999 281.29001 m 565.90002 281.29001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 292.70001 m 568.10004 292.70001 l S 28.99001 269.87 m 568.10004 269.87 l S 30.07001 293.78 m 30.07001 268.80002 l S 316.37 293.78 m 316.37 268.80002 l S 347.66998 293.78 m 347.66998 268.80002 l S 379.01999 293.78 m 379.01999 268.80002 l S 410.31998 293.78 m 410.31998 268.80002 l S 441.66998 293.78 m 441.66998 268.80002 l S 473.01999 293.78 m 473.01999 268.80002 l S 504.31998 293.78 m 504.31998 268.80002 l S 535.66998 293.78 m 535.66998 268.80002 l S 567.01996 293.78 m 567.01996 268.80002 l S BT /T1_0 12 Tf 1 0 0 1 34.05 276.51999 Tm (Date of last inspection)Tj 1 0 0 1 328.20001 276.51999 Tm (0)Tj 1 0 0 1 359.53 276.51999 Tm (4)Tj 1 0 0 1 390.85999 276.51999 Tm (1)Tj 1 0 0 1 422.17999 276.51999 Tm (1)Tj 1 0 0 1 453.53 276.51999 Tm (2)Tj 1 0 0 1 484.85999 276.51999 Tm (0)Tj 1 0 0 1 516.17999 276.51999 Tm (0)Tj 1 0 0 1 547.52997 276.51999 Tm (8)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 258 m 565.90002 258 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 248.37 m 568.10004 248.37 l S 30.07001 249.45 m 30.07001 39.14999 l S 567.01996 249.45 m 567.01996 39.14999 l S 28.99001 267.62 m 568.10004 267.62 l S 28.99001 248.37 m 568.10004 248.37 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 268.70001 m 30.07001 247.28998 l S 567.01996 268.70001 m 567.01996 247.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 254.43999 Tm (Brief description of the )Tj 1 0 0 1 177.31 254.43999 Tm (care home)Tj 1 0 0 1 35.5 235.18999 Tm (Honiton Manor is registered to provide 24 hour nursing care for up to 22\ service users )Tj 1 0 0 1 35.5 218.19 Tm (who have needs relating to 'older people'.)Tj 1 0 0 1 35.5 201.19 Tm (\240)Tj 1 0 0 1 35.5 184.19 Tm (The two-storey home is an older style building situated on the main road\ into, and )Tj 1 0 0 1 35.5 167.19 Tm (quite close to, Honiton and the local amenities. It is on public transpo\ rt routes.)Tj 1 0 0 1 35.5 150.19 Tm (\240)Tj 1 0 0 1 35.5 133.19 Tm (There are eleven single bedrooms and five double bedrooms situated on th\ e ground )Tj 1 0 0 1 35.5 116.19 Tm (and first floors. One of the double bedrooms has an ensuite bathroom. A \ passenger lift )Tj 1 0 0 1 35.5 99.19 Tm (and a staircase link the floors.)Tj 1 0 0 1 35.5 82.19 Tm (\240)Tj 1 0 0 1 35.5 65.19 Tm (Communal space is made up of a large lounge and a dining room, both on t\ he ground )Tj 1 0 0 1 35.5 48.19 Tm (floor.)Tj ET endstream endobj 979 0 obj 1404 endobj 980 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 689.07996 l S 567.01996 795.47998 m 567.01996 689.07996 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 690.14996 m 568.10004 690.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (\240)Tj 1 0 0 1 33.25 766.46997 Tm (Outside there is access to a seating area and parking.)Tj 1 0 0 1 33.25 749.46997 Tm (\240)Tj 1 0 0 1 33.25 732.46997 Tm (Current charges are \243515.00 - \243675.00 per week. Charges do not inc\ lude items such )Tj 1 0 0 1 33.25 715.46997 Tm (as newspapers, toiletries, taxis etc.)Tj 1 0 0 1 33.25 698.46997 Tm (\240)Tj ET endstream endobj 981 0 obj 3597 endobj 982 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (This unannounced key inspection was due to be undertaken in November 200\ 9. It was )Tj 1 0 0 1 35.17 240.90001 Tm (bought forward as we had received some concerns about the quality of car\ e that )Tj 1 0 0 1 35.17 226.31998 Tm (people living here are receiving.)Tj 1 0 0 1 35.17 211.73999 Tm (\240)Tj 1 0 0 1 35.17 197.14998 Tm (During this visit we \(the commission\) spoke with or observed the major\ ity of people )Tj 1 0 0 1 35.17 182.56999 Tm (living here. We could not speak with some people because they have commu\ nication )Tj 1 0 0 1 35.17 167.98999 Tm (difficulties such as dementia. We looked closely at the care, services a\ nd )Tj 1 0 0 1 35.17 153.41 Tm (accommodation offered to four people living here. This is called case tr\ acking and helps )Tj 1 0 0 1 35.17 138.84 Tm (us to make a judgment about the standard of care overall, and helps us t\ o understand )Tj 1 0 0 1 35.17 124.25 Tm (the experiences of people who live here.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (We looked at the care and attention given by staff to these people and w\ e looked at )Tj 1 0 0 1 35.17 80.50999 Tm (their assessments and at their care planning records. We looked at the e\ nvironment in )Tj 1 0 0 1 35.17 65.93001 Tm (relation to their needs and how their health and personal care needs are\ met. We also )Tj ET endstream endobj 983 0 obj 2315 endobj 984 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 280.01999 w 32.32001 672.51996 m 566.71997 672.51996 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 531.38 m 568.91998 531.38 l S 31.2 814.72998 m 31.2 530.31 l S 567.84998 814.72998 m 567.84998 530.31 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (spoke with visitors to the home, with staff and with the manager and one\ of the )Tj 1 0 0 1 32.92 788.13995 Tm (owners. We visited the majority of bedrooms and saw all service and comm\ unal areas )Tj 1 0 0 1 32.92 773.56 Tm (of the home.)Tj 1 0 0 1 32.92 758.97998 Tm (\240)Tj 1 0 0 1 32.92 744.40002 Tm (We looked at records relating to accidents and incidents, staff training\ , staff )Tj 1 0 0 1 32.92 729.82001 Tm (recruitment, medication and at some policies.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (Prior to the inspection the owners sent us their Annual Quality Assuranc\ e Assessment )Tj 1 0 0 1 32.92 686.07996 Tm (\(AQAA\) which gave us information about the home and it's management an\ d about the )Tj 1 0 0 1 32.92 671.5 Tm (needs of people living here. This document asks for evidence in relation\ to what the )Tj 1 0 0 1 32.92 656.91998 Tm (home does well and what they think they can improve upon.)Tj 1 0 0 1 32.92 642.33997 Tm (\240)Tj 1 0 0 1 32.92 627.76001 Tm (In addition, we sent surveys to 8 people living here and 3 were returned\ . We sent 8 )Tj 1 0 0 1 32.92 613.17999 Tm (surveys to staff and 3 were returned. We sent 4 surveys to health and so\ cial care )Tj 1 0 0 1 32.92 598.60004 Tm (professionals and all were returned. Feedback and comments are included \ in the )Tj 1 0 0 1 32.92 584.01996 Tm (report.)Tj 1 0 0 1 32.92 569.44 Tm (\240)Tj 1 0 0 1 32.92 554.85999 Tm (During this inspection evidence was taken under the Police and Criminal \ Evidence Act )Tj 1 0 0 1 32.92 540.27997 Tm (and this has been considered under our enforcement procedures.)Tj ET endstream endobj 985 0 obj 6453 endobj 986 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 64.32001 w 32.32001 741.65997 m 566.71997 741.65997 l S 20.58 w 32.7 696.95996 m 569.34998 696.95996 l S 93.48 w 33.82001 637.67999 m 568.21997 637.67999 l S 20.58 w 33.45 578.40002 m 570.10004 578.40002 l S 501.84 w 34.57001 314.94998 m 568.96997 314.94998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 708.38 m 568.91998 708.38 l S 31.2 776.02997 m 31.2 707.29999 l S 31.2 708.38 m 569.34998 708.38 l S 32.7 685.54999 m 569.34998 685.54999 l S 31.62 685.54999 m 570.41998 685.54999 l S 31.62 589.82001 m 570.41998 589.82001 l S 33.45 566.98999 m 570.10004 566.98999 l S 33.45 589.82001 m 570.10004 589.82001 l S 32.37 566.98999 m 571.16998 566.98999 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 686.63 m 32.7 588.73999 l S 33.45 568.07001 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 707.29999 l S 569.34998 686.63 m 569.34998 588.73999 l S 570.10004 568.07001 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (This home is warm, clean and comfortable. Staff are described as nice an\ d caring and )Tj 1 0 0 1 35.17 744.17999 Tm (as doing their best. The home has a lot of nursing equipment such as adj\ ustable beds )Tj 1 0 0 1 35.17 729.60004 Tm (and pressure relieving mattresses. People really enjoy the food served h\ ere which is )Tj 1 0 0 1 35.17 715.01996 Tm (nutritious and offers variety. )Tj /T1_0 10 Tf 1 0 0 1 568.96997 740.10999 Tm (\240)Tj 1 0 0 1 31.2 694.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 692.19 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 695.40997 Tm (\240)Tj 1 0 0 1 31.2 636.13 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 669.35999 Tm (Since the last inspection the programme of redecoration has continued. W\ e saw that a )Tj 1 0 0 1 36.67 654.77997 Tm (window was being replaced and that the front door is now secured with a \ key pad type )Tj 1 0 0 1 36.67 640.20001 Tm (lock.)Tj 1 0 0 1 36.67 625.62 Tm (The home has employed a part time activities co-ordinator and this perso\ n's efforts are )Tj 1 0 0 1 36.67 611.03998 Tm (having an impact for some people.)Tj 1 0 0 1 36.67 596.45996 Tm (The Requirement made at the last inspection in relation to medicines has\ been met. )Tj /T1_0 10 Tf 1 0 0 1 570.46997 636.13 Tm (\240)Tj 1 0 0 1 31.2 576.84998 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 573.63 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 313.38998 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 550.79999 Tm (This home does not have a registered manager and is not being sufficient\ ly well )Tj 1 0 0 1 37.42 536.21997 Tm (managed. This has resulted in people's health and welfare needs not alwa\ ys being )Tj 1 0 0 1 37.42 521.64001 Tm (assessed or met. The care planning and communicating systems in place ar\ e not )Tj 1 0 0 1 37.42 507.06 Tm (sufficiently robust to ensure that care staff have the information they \ need about )Tj 1 0 0 1 37.42 492.47998 Tm (people's care needs and how these should be met.)Tj 1 0 0 1 37.42 477.89993 Tm (\240)Tj 1 0 0 1 37.42 463.31998 Tm (Staff are well intentioned but are not always on duty in sufficient numb\ ers, and do not )Tj 1 0 0 1 37.42 448.73999 Tm (always have the support they need, to meet people's needs. On one night \ there was )Tj 1 0 0 1 37.42 434.16 Tm (not a waking Registered Nurse on duty. Staff are not recruited in a robu\ st way and this )Tj 1 0 0 1 37.42 419.57999 Tm (means that people are at risk of being cared for by inappropriate staff.\ )Tj 1 0 0 1 37.42 405 Tm (\240)Tj 1 0 0 1 37.42 390.41998 Tm (People are not always treated with dignity and their rights to make choi\ ces or to be )Tj 1 0 0 1 37.42 375.84 Tm (engaged and sociable are not always supported. Some people's sense of se\ lf and )Tj 1 0 0 1 37.42 361.25998 Tm (personal identity is in danger of being eroded by a system that is not a\ lways person )Tj 1 0 0 1 37.42 346.67999 Tm (centred and is sometimes institutionalised.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Complaints have been made to the commission by some people. They complai\ n that )Tj 1 0 0 1 37.42 302.94 Tm (the home is not well managed and the quality of care has declined. These\ concerns are )Tj 1 0 0 1 37.42 288.35999 Tm (being investigated by the local safeguarding team. This is the second sa\ feguarding )Tj 1 0 0 1 37.42 273.78 Tm (alert that has been made since the last inspection. Whilst this investig\ ation is ongoing, )Tj 1 0 0 1 37.42 259.20001 Tm (admissions to this home via health or social care services have been sus\ pended by )Tj 1 0 0 1 37.42 244.62 Tm (Adult and Community Services.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Staff training is not up to date and some specialist training is being d\ esignated to )Tj 1 0 0 1 37.42 200.87999 Tm (people who are not qualified or experienced to carry this out.)Tj 1 0 0 1 37.42 186.3 Tm (\240)Tj 1 0 0 1 37.42 171.72 Tm (Some working practices and systems are not ensuring people's safety. Thi\ s includes )Tj 1 0 0 1 37.42 157.14 Tm (moving and handling people, ensuring windows are restricted to prevent a\ ccidental )Tj 1 0 0 1 37.42 142.56 Tm (falls, the maintenance of equipment and risk assessments and actions in \ relation to the )Tj 1 0 0 1 37.42 127.98 Tm (use of restraint. Systems are not robust enough to ensure that it is cle\ ar which staff )Tj 1 0 0 1 37.42 113.40001 Tm (have received mandatory training and which have not. The system for reco\ rding and )Tj 1 0 0 1 37.42 98.82001 Tm (monitoring accidents and incidents is not being used to help prevent fur\ ther accidents.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (The commission have not been kept informed in relation to all incidents,\ accidents and )Tj ET endstream endobj 987 0 obj 2243 endobj 988 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (46)Tj ET 1 1 1 RG 148.8 w 34.57001 738.13 m 568.96997 738.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 662.60004 m 571.16998 662.60004 l S 33.45 814.72998 m 33.45 661.52997 l S 570.10004 814.72998 m 570.10004 661.52997 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (deaths in the home, as we should be so that we can monitor this type of \ activity in the )Tj 1 0 0 1 35.17 788.13995 Tm (home.)Tj 1 0 0 1 35.17 773.56 Tm (\240)Tj 1 0 0 1 35.17 758.97998 Tm (Statutory Requirement Notices have been issued to the registered owners \ of this )Tj 1 0 0 1 35.17 744.40002 Tm (service. These Notices inform the providers that they have failed to com\ ply with the )Tj 1 0 0 1 35.17 729.82001 Tm (Care Home Regulations 2001 in relation to planning people's care and in \ relation to )Tj 1 0 0 1 35.17 715.23999 Tm (meeting people's health and welfare needs. The Statutory Requirement Not\ ices tell the )Tj 1 0 0 1 35.17 700.65997 Tm (providers what they must do and gives them dates by when the failures id\ entified must )Tj 1 0 0 1 35.17 686.07996 Tm (be addressed.)Tj 1 0 0 1 35.17 671.5 Tm (\240)Tj 1 0 0 1 28.35001 648.03998 Tm (\240)Tj 1 0 0 1 28.35001 628.04999 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 628.04999 Tm (care home)Tj 1 0 0 1 480.03998 628.04999 Tm ( is taking )Tj 1 0 0 1 28.35001 610.54999 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 590.56 Tm (\240)Tj 1 0 0 1 28.35001 570.56 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 570.56 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 550.56 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 550.56 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 530.57001 Tm (order line 0870 240 7535.)Tj ET endstream endobj 989 0 obj 1804 endobj 990 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 991 0 obj 5905 endobj 992 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (Some people move into this home without having their needs fully assesse\ d and )Tj 1 0 0 1 36.62 341.25 Tm (without agreement from the funding authority. This means that people can\ not be sure )Tj 1 0 0 1 36.62 323.75998 Tm (that their needs will be met in an appropriate way or that they will be \ staying in this )Tj 1 0 0 1 36.62 306.25998 Tm (home. )Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (In surveys two out of three people who live here told us that they had t\ he information )Tj 1 0 0 1 36.57001 216.78 Tm (they needed to decide if this was the home for them. In addition, two ou\ t of three )Tj 1 0 0 1 36.57001 199.28 Tm (health care professionals say that the home's assessment arrangements us\ ually )Tj 1 0 0 1 36.57001 181.78998 Tm (ensure that accurate information is gathered and that the right service \ is planned for )Tj 1 0 0 1 36.57001 164.28999 Tm (people. One health care professional told us that this always happens.)Tj 1 0 0 1 36.57001 146.78999 Tm (\240)Tj 1 0 0 1 36.57001 129.3 Tm (We were told that the home had admitted two people to this home without \ an )Tj 1 0 0 1 36.57001 111.8 Tm (assessment by and without the agreement of the funding authority. When w\ e looked )Tj 1 0 0 1 36.57001 94.31 Tm (at records we found these people had been admitted from a residential ho\ me owned )Tj ET endstream endobj 993 0 obj 2644 endobj 994 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 336.30002 w 34.60001 643.26001 m 562.53998 643.26001 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 314.92999 w 33.47 631.44 m 563.65997 631.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 471.78 l S 564.78998 791.10999 m 564.78998 471.78 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 472.85999 m 565.87 472.85999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (by the owners of this home.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We spoke with staff who told us that one of these people had moved here \ because )Tj 1 0 0 1 34.32001 726.60999 Tm (they have nursing needs and therefore need their care to be planned and \ delivered by )Tj 1 0 0 1 34.32001 709.10999 Tm (registered nurses.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We looked at the records of one of these people. We found that an assess\ ment of their )Tj 1 0 0 1 34.32001 656.63 Tm (nursing needs had not taken place prior to their admission, or since the\ ir admission. )Tj 1 0 0 1 34.32001 639.13 Tm (We found that all assessments in their records have been carried out in \ the home they )Tj 1 0 0 1 34.32001 621.63 Tm (used to live in.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (We could not speak with this person about their feelings about the move \ as they have )Tj 1 0 0 1 34.32001 569.14996 Tm (communication difficulties. We spoke with the relative of another person\ living here. )Tj 1 0 0 1 34.32001 551.64996 Tm (They told us that they had looked around the home and at the bedroom the\ person )Tj 1 0 0 1 34.32001 534.14996 Tm (would move into. They were able to ask questions about the home before d\ eciding this )Tj 1 0 0 1 34.32001 516.65997 Tm (was the right home. However, we noted that this person's care record did\ not contain )Tj 1 0 0 1 34.32001 499.16 Tm (pre admission information from health and social care professionals as i\ t should.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj ET endstream endobj 995 0 obj 5782 endobj 996 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 403.25 m 562.53998 403.25 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 119.35001 w 33.47 392 m 563.65997 392 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 330.12 l S 564.78998 453.88 m 564.78998 330.12 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 331.20001 m 565.87 331.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (Peoples' medicines are safely managed. However, some people are being pu\ t at risk )Tj 1 0 0 1 36.62 375.25 Tm (because their health and welfare needs are not being met. People do not \ have their )Tj 1 0 0 1 36.62 357.75998 Tm (care planned in a person centred way that treats them as individuals and\ are not )Tj 1 0 0 1 36.62 340.25998 Tm (always treated with dignity. )Tj 1 0 0 1 28.35001 315.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.3 w 34.60001 193.67999 m 562.53998 193.67999 l S 1 1 1 RG 22.5 w 32.35001 296.32999 m 564.78998 296.32999 l S 201.92998 w 33.47 181.87 m 563.65997 181.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 283.95999 m 565.87 283.95999 l S 32.35001 285.04001 m 32.35001 78.70001 l S 564.78998 285.04001 m 564.78998 78.70001 l S 32.35001 283.95999 m 564.78998 283.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.26999 Tm (In surveys people living here told us they usually get the care and supp\ ort they need )Tj 1 0 0 1 36.57001 250.78 Tm (and that they always or usually get the medical support they need.)Tj 1 0 0 1 36.57001 233.28 Tm (\240)Tj 1 0 0 1 36.57001 215.78998 Tm (Two health care professionals told us that people's health care needs ar\ e always )Tj 1 0 0 1 36.57001 198.28998 Tm (properly monitored and one told us this usually happens. Two also said t\ hat the staff )Tj 1 0 0 1 36.57001 180.78998 Tm (at the home seek advice and act on it to improve well being, and one sai\ d that this )Tj 1 0 0 1 36.57001 163.3 Tm (sometimes happened. Comments from health care professionals include that\ staff act )Tj 1 0 0 1 36.57001 145.8 Tm (promptly to get medical help for people who need it and that some people\ have )Tj 1 0 0 1 36.57001 128.31 Tm (blossomed since living here.)Tj 1 0 0 1 36.57001 110.81 Tm (\240)Tj 1 0 0 1 36.57001 93.31 Tm (We looked in depth at the care plans of four people living here. We also\ looked at )Tj ET endstream endobj 997 0 obj 5378 endobj 998 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (some others. We found that each person has a plan of care and that these\ contain a )Tj 1 0 0 1 34.32001 761.60004 Tm (large number and range of documents relating to care needs. However, the\ se )Tj 1 0 0 1 34.32001 744.10999 Tm (documents were not person centred, are sometimes contradictory and do no\ t always )Tj 1 0 0 1 34.32001 726.60999 Tm (provide care staff with the detailed information that they need to meet \ people's needs.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (For example one person that we case tracked has been admitted from the o\ wners' )Tj 1 0 0 1 34.32001 674.12 Tm (residential home. This person's care plan is the care plan from that hom\ e. Staff told us )Tj 1 0 0 1 34.32001 656.63 Tm (that the reason this person was admitted to this home was because staff \ believe that )Tj 1 0 0 1 34.32001 639.13 Tm (they need the 24 hour care of nurses. However, nurses have not devised a\ care plan )Tj 1 0 0 1 34.32001 621.63 Tm (as to how this person's nursing needs are to be met. In addition, inform\ ation recorded )Tj 1 0 0 1 34.32001 604.14001 Tm (in the daily notes from the residential home has not been followed up. B\ efore being )Tj 1 0 0 1 34.32001 586.64001 Tm (admitted to this home, it was recorded that this person has a urinary ca\ theter, is )Tj 1 0 0 1 34.32001 569.14996 Tm (prone to urinary tract infections and needs encouragement to drink. Two \ days before )Tj 1 0 0 1 34.32001 551.64996 Tm (being admitted it is recorded that this person had very strong and dark \ urine which )Tj 1 0 0 1 34.32001 534.14996 Tm (means this person may not be drinking enough fluid. This person has live\ d in this care )Tj 1 0 0 1 34.32001 516.65997 Tm (home for approximately 6 weeks and the care notes have not mentioned thi\ s person's )Tj 1 0 0 1 34.32001 499.16 Tm (urine. We asked staff about this and they told us that the night staff e\ mpty the )Tj 1 0 0 1 34.32001 481.66998 Tm (catheter bag and that they didn't know how much urine this person passed\ or what )Tj 1 0 0 1 34.32001 464.16998 Tm (colour it is.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked to see how much this person drinks in a day because the reside\ ntial care )Tj 1 0 0 1 34.32001 411.67999 Tm (home instructions state that they should be encouraged to drink to preve\ nt urinary )Tj 1 0 0 1 34.32001 394.19 Tm (tract infections. We saw records that show this person drinks between 20\ 0mls and )Tj 1 0 0 1 34.32001 376.69 Tm (1050mls in a day. The records do not contain instructions about how much\ this person )Tj 1 0 0 1 34.32001 359.19 Tm (should drink in a day. We asked carers how much this person should drink\ to keep )Tj 1 0 0 1 34.32001 341.70001 Tm (them healthy and they thought that this would be about 1000mls. We asked\ carers if )Tj 1 0 0 1 34.32001 324.20001 Tm (they knew how much this person had drunk in the past days and they said \ they did )Tj 1 0 0 1 34.32001 306.70999 Tm (not because the nurse totals up the amount drunk. A nurse has reviewed t\ he records )Tj 1 0 0 1 34.32001 289.20999 Tm (kept about this person and the amount they have drunk. They record, in d\ ifferent )Tj 1 0 0 1 34.32001 271.70999 Tm (places in the care plan, that they have drunk a fair amount, small amoun\ t and a good )Tj 1 0 0 1 34.32001 254.22 Tm (amount. However, these reviews do not appear to have taken into account \ the days )Tj 1 0 0 1 34.32001 236.72 Tm (when this person has only drunk 200mls, 350mls and 400mls. We have calcu\ lated )Tj 1 0 0 1 34.32001 219.23 Tm (that this person, according to their weight, should have at least 1880ml\ s to drink each )Tj 1 0 0 1 34.32001 201.73 Tm (day. We spoke with the temporary manager about how much people should dr\ ink. She )Tj 1 0 0 1 34.32001 184.23 Tm (told us she knows there is a calculation to work this out, but does not \ know what it is. )Tj 1 0 0 1 34.32001 166.73999 Tm (We also noted that records show that this person does not have a drink b\ etween 6pm )Tj 1 0 0 1 34.32001 149.23999 Tm (and 8 or 9am. This is a very long time for someone who has a catheter an\ d is prone to )Tj 1 0 0 1 34.32001 131.75 Tm (urinary tract infections.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (We observed this person on the day of this inspection. They had numerous\ drinks put )Tj ET endstream endobj 999 0 obj 5195 endobj 1000 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (in front of them by members of staff. No encouragement to drink was give\ n by staff, )Tj 1 0 0 1 34.32001 761.60004 Tm (but was given by their wife. we would estimate that this person drank ap\ proximately )Tj 1 0 0 1 34.32001 744.10999 Tm (50mls between 10am and 1pm.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We also saw that other people do not have enough to drink.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We saw in care plans that people are assessed to see if they are at risk\ of developing )Tj 1 0 0 1 34.32001 656.63 Tm (pressure sores. We saw that people we had case tracked are at risk. Thes\ e people are )Tj 1 0 0 1 34.32001 639.13 Tm (cared for on pressure relieving mattresses and cushions as is good pract\ ice. Some )Tj 1 0 0 1 34.32001 621.63 Tm (people are also nursed on adjustable beds which is also good practice. W\ e were told )Tj 1 0 0 1 34.32001 604.14001 Tm (that one person has developed a pressure sore since coming to live here \ and that one )Tj 1 0 0 1 34.32001 586.64001 Tm (person came to the home having already developed a pressure sore. We loo\ ked at )Tj 1 0 0 1 34.32001 569.14996 Tm (some pressure relieving equipment. We found one mattress had been set to\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (maximum pressure indicating that the person using this mattress is heavy\ . When we )Tj 1 0 0 1 34.32001 534.14996 Tm (looked in care records we found that this person is very light. We asked\ staff how they )Tj 1 0 0 1 34.32001 516.65997 Tm (work out the pressure that the mattress should be set to. One person sai\ d they did )Tj 1 0 0 1 34.32001 499.16 Tm (not know, another said the person setting it up does it. We looked in ca\ re plans, in )Tj 1 0 0 1 34.32001 481.66998 Tm (people's bedrooms and on the mattress motors to see if staff have access\ to )Tj 1 0 0 1 34.32001 464.16998 Tm (instructions about the pressure each mattress should be set at. We did n\ ot find any )Tj 1 0 0 1 34.32001 446.66998 Tm (instructions.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We saw in care plans that some people are at risk of malnutrition. One p\ erson we case )Tj 1 0 0 1 34.32001 394.19 Tm (tracked is losing weight. The GP has been informed. However, the recomme\ ndations )Tj 1 0 0 1 34.32001 376.69 Tm (made by the specialist nutritional tool used \(MUST\) have not been foll\ owed. According )Tj 1 0 0 1 34.32001 359.19 Tm (to this person's level of risk they should be having specific drinks to \ supplement their )Tj 1 0 0 1 34.32001 341.70001 Tm (calorie intake. Records show that these are given intermittently and not\ routinely. We )Tj 1 0 0 1 34.32001 324.20001 Tm (asked staff if this person has supplement drinks and they said no.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We noted in another person's records that they had been having loose bow\ el motions )Tj 1 0 0 1 34.32001 271.70999 Tm (and saw and heard from a relative that they had been off their food. Rec\ ords also )Tj 1 0 0 1 34.32001 254.22 Tm (show that this person has been what is described as 'grumpy'. This perso\ n has been )Tj 1 0 0 1 34.32001 236.72 Tm (weighed weekly. Although the most recent weight shows a weight gain, the\ general )Tj 1 0 0 1 34.32001 219.23 Tm (trend is that this person is losing weight. There was no record to show \ that this is )Tj 1 0 0 1 34.32001 201.73 Tm (being addressed. Staff are not keeping records of what this person eats \ and drinks. A )Tj 1 0 0 1 34.32001 184.23 Tm (nurse had recorded that they had reviewed this care plan but had not tak\ en any action )Tj 1 0 0 1 34.32001 166.73999 Tm (to address these health issues. This means that this person's health is \ not being )Tj 1 0 0 1 34.32001 149.23999 Tm (monitored appropriately and might result in a delay in appropriate actio\ n being taken.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (Prior to this inspection, the owners provided us with an updated improve\ ment plan in )Tj 1 0 0 1 34.32001 96.75 Tm (relation to requirements made at the last inspection about meeting peopl\ e's nutritional )Tj ET endstream endobj 1001 0 obj 5376 endobj 1002 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs. This told us that the completion of the nutritional risk assessme\ nt tool \(MUST\) )Tj 1 0 0 1 34.32001 761.60004 Tm (and for taking action if risk is identified has been designated to the c\ atering manager. )Tj 1 0 0 1 34.32001 744.10999 Tm (This person, along with other staff in the home, has received training i\ n relation to )Tj 1 0 0 1 34.32001 726.60999 Tm (nutrition from a company that supplies nutritional supplements. However,\ this does )Tj 1 0 0 1 34.32001 709.10999 Tm (not qualify them to carry out these assessments or to determine the acti\ ons that )Tj 1 0 0 1 34.32001 691.62 Tm (should be taken.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (Another care plan recorded that one person stays in bed all day and does\ not get )Tj 1 0 0 1 34.32001 639.13 Tm (dressed. It states the reason for this as them being immobile and having\ contractures )Tj 1 0 0 1 34.32001 621.63 Tm (of their legs. Records do not include evidence that consideration has be\ en given, or )Tj 1 0 0 1 34.32001 604.14001 Tm (that actions have been taken, to make arrangements or find moving and ha\ ndling )Tj 1 0 0 1 34.32001 586.64001 Tm (equipment that might allow this person to move out of their bed.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We looked at other records relating to people with dementia. Care plans \ state for )Tj 1 0 0 1 34.32001 534.14996 Tm (example, that some people have a poor mental state and reduced powers of\ )Tj 1 0 0 1 34.32001 516.65997 Tm (comprehension. However, care plans do not provide a plan as to how these\ people's )Tj 1 0 0 1 34.32001 499.16 Tm (mental health and welfare needs are to be addressed or met. In addition,\ it has been )Tj 1 0 0 1 34.32001 481.66998 Tm (agreed on three people's behalf, who are described as confused or having\ dementia, )Tj 1 0 0 1 34.32001 464.16998 Tm (that they would like to get them up as early as 6am. One of these people\ has an )Tj 1 0 0 1 34.32001 446.66998 Tm (illness the symptoms of which include stiffness, especially in the morni\ ng and fatigue. )Tj 1 0 0 1 34.32001 429.17999 Tm (These symptoms do not seem to have been considered in the decision to ge\ t them up )Tj 1 0 0 1 34.32001 411.67999 Tm (early.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We observed that one person is at high risk of choking as they have diff\ iculty )Tj 1 0 0 1 34.32001 359.19 Tm (swallowing. This person was referred to the Speech and Language Therapis\ t \(SALT\) )Tj 1 0 0 1 34.32001 341.70001 Tm (some time ago. However, a visiting health care professional observed tha\ t staff were )Tj 1 0 0 1 34.32001 324.20001 Tm (not following the guidance given by the SALT. They asked this specialist\ to visit again. )Tj 1 0 0 1 34.32001 306.70999 Tm (Instructions were left for staff to follow as to how this person is to b\ e supported to )Tj 1 0 0 1 34.32001 289.20999 Tm (eat. We saw that some of this guidance is being put into practice. Howev\ er, we also )Tj 1 0 0 1 34.32001 271.70999 Tm (saw that some is not. For example, we saw that nurses saw a visitor offe\ ring this )Tj 1 0 0 1 34.32001 254.22 Tm (person a chocolate covered wafer. They did not explain to the visitor th\ at this might )Tj 1 0 0 1 34.32001 236.72 Tm (cause problems for this person's swallowing. We saw this person in their\ wheelchair, )Tj 1 0 0 1 34.32001 219.23 Tm (leaning over to one side after lunch. This person is meant to sit up for\ 30 mins after )Tj 1 0 0 1 34.32001 201.73 Tm (eating. We saw that a member of staff put this person to bed soon after \ lunch, lying )Tj 1 0 0 1 34.32001 184.23 Tm (down. We asked staff about how this person is supported to eat and not c\ hoke. They )Tj 1 0 0 1 34.32001 166.73999 Tm (told us what they knew, but did not know that this person should be sat \ up for 30mins )Tj 1 0 0 1 34.32001 149.23999 Tm (after they had eaten. Staff told us this person has a pureed diet which \ complies with )Tj 1 0 0 1 34.32001 131.75 Tm (the SALT instructions. They also told us that they give this person cake\ and biscuits, )Tj 1 0 0 1 34.32001 114.25 Tm (which puts this person at risk of choking. The care plan does not contai\ n instructions )Tj 1 0 0 1 34.32001 96.75 Tm (for staff about what to do if this person chokes. One carer told us they\ would use their )Tj ET endstream endobj 1003 0 obj 5253 endobj 1004 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (common sense and try a grab and thrust movement. A nurse told us she hop\ ed that )Tj 1 0 0 1 34.32001 761.60004 Tm (staff would know to call a nurse or 999. This lack of instruction means \ that there may )Tj 1 0 0 1 34.32001 744.10999 Tm (be a delay in this person getting appropriate help.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We asked the manager how staff have been given information about this pe\ rson's )Tj 1 0 0 1 34.32001 691.62 Tm (needs and risk of choking since the most recent visit by the SALT. We we\ re told that )Tj 1 0 0 1 34.32001 674.12 Tm (the nurses had been told about the special requirements for this person,\ and the )Tj 1 0 0 1 34.32001 656.63 Tm (nurses were named, and that they give this information to the carers. We\ saw from )Tj 1 0 0 1 34.32001 639.13 Tm (the duty rota that one of these nurses had been on sick leave over this \ period. The )Tj 1 0 0 1 34.32001 621.63 Tm (manager confirmed this adding that the nurses already knew about the adv\ ice. We )Tj 1 0 0 1 34.32001 604.14001 Tm (reminded her that the SALT referral was made again because staff were no\ t following )Tj 1 0 0 1 34.32001 586.64001 Tm (the advice given, and this was putting this person at risk of choking.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We saw in the improvement plan provided by the owners that staff have ha\ d training )Tj 1 0 0 1 34.32001 534.14996 Tm (from the SALT in supporting people who have difficulties swallowing. Thi\ s document )Tj 1 0 0 1 34.32001 516.65997 Tm (also tells us that further updates will be given by the catering manager\ . This person is )Tj 1 0 0 1 34.32001 499.16 Tm (not qualified to do this and this is not good practice. We have checked \ with the SALT )Tj 1 0 0 1 34.32001 481.66998 Tm (and they have told us that they are happy to provide further training if\ needed.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We saw that many people living here have mobility problems. We checked c\ are plans )Tj 1 0 0 1 34.32001 429.17999 Tm (to see if people had had their moving and handling needs assessed. We fo\ und that )Tj 1 0 0 1 34.32001 411.67999 Tm (some people had not had these needs assessed. We found another that was \ dated )Tj 1 0 0 1 34.32001 394.19 Tm (April 2007 which had not been reviewed or updated since that time. Care \ plans give )Tj 1 0 0 1 34.32001 376.69 Tm (very general instructions for care staff such as 'needs hoist'. They did\ not specify the )Tj 1 0 0 1 34.32001 359.19 Tm (type of hoist to be used or the size of sling. We spoke to a nurse about\ how staff know )Tj 1 0 0 1 34.32001 341.70001 Tm (which hoist and sling to use. The nurse told us that if a person is on t\ he ground floor )Tj 1 0 0 1 34.32001 324.20001 Tm (they use the hoist that is on that floor and that carers make a judgment\ about what )Tj 1 0 0 1 34.32001 306.70999 Tm (size sling to use. This means that carers are not being supported to ens\ ure that they )Tj 1 0 0 1 34.32001 289.20999 Tm (use the appropriate equipment for each person.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (We also noted that the hoist is often used to help people who have been \ incontinent of )Tj 1 0 0 1 34.32001 236.72 Tm (urine. We saw that people share slings which does not help to prevent th\ e spread of )Tj 1 0 0 1 34.32001 219.23 Tm (infection and indicates that care is de-personalised.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Care plans in this home are in two parts. There is a larger comprehensiv\ e part which )Tj 1 0 0 1 34.32001 166.73999 Tm (contains details relating to the person and the plan of care. There is a\ lso a day to day )Tj 1 0 0 1 34.32001 149.23999 Tm (record which the manager told us is what carers use. Instructions in the\ se smaller )Tj 1 0 0 1 34.32001 131.75 Tm (records contain task orientated information such as needs feeding, hoist\ , weekly )Tj 1 0 0 1 34.32001 114.25 Tm (weight and on fluid chart. These are not person centred and do not give \ care staff the )Tj 1 0 0 1 34.32001 96.75 Tm (information they need to provide individualised care based on each perso\ n's individual )Tj ET endstream endobj 1005 0 obj 4999 endobj 1006 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (needs and preferences.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (Carers told us they do not tend to read care plans, although they do wri\ te in them. For )Tj 1 0 0 1 34.32001 726.60999 Tm (example they record fluid and food intake if people need to have this re\ corded. We )Tj 1 0 0 1 34.32001 709.10999 Tm (found that entries made by staff include impersonal comments such as pad\ changed, )Tj 1 0 0 1 34.32001 691.62 Tm (repositioned, soaking wet bed, usual day and nothing new. This type of l\ anguage is an )Tj 1 0 0 1 34.32001 674.12 Tm (indicator that the provision of care is task orientated and de personali\ sed.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (We asked how staff get the information they need about people and their \ needs if they )Tj 1 0 0 1 34.32001 621.63 Tm (do not read care plans. They told us they know people, or get to know th\ em. They say )Tj 1 0 0 1 34.32001 604.14001 Tm (they do not get a handover of information when they come on duty, that o\ nly the )Tj 1 0 0 1 34.32001 586.64001 Tm (nurse gets this. They say they start work straight away. They know who n\ eeds getting )Tj 1 0 0 1 34.32001 569.14996 Tm (up and who needs breakfast. We asked the temporary manager how it is ens\ ure that )Tj 1 0 0 1 34.32001 551.64996 Tm (carers have the information they need to care for people and were told t\ hat she would )Tj 1 0 0 1 34.32001 534.14996 Tm (hope nurses give this. This means there is not a robust system in place \ to ensure that )Tj 1 0 0 1 34.32001 516.65997 Tm (care staff have the information and guidance they need to ensure that pe\ ople's needs )Tj 1 0 0 1 34.32001 499.16 Tm (are met.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We saw that care plans are reviewed by nurses. However, we noted that de\ spite )Tj 1 0 0 1 34.32001 446.66998 Tm (changes in people's conditions that there were no changes to the plans o\ f care. We )Tj 1 0 0 1 34.32001 429.17999 Tm (also noted that reviews of care plans do not record what information has\ been used to )Tj 1 0 0 1 34.32001 411.67999 Tm (make the nursing decisions.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (The pharmacist inspector inspected the way that medicines are managed in\ this home. )Tj 1 0 0 1 34.32001 359.19 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 341.70001 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 324.20001 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 306.70999 Tm (were told that sometimes people can look after and take their own medici\ nes. There )Tj 1 0 0 1 34.32001 289.20999 Tm (are not any people living in the home at the moment who do this, and peo\ ple are )Tj 1 0 0 1 34.32001 271.70999 Tm (given their medicines by nursing staff.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (Medicines are stored safely for the protection of people in the home. Th\ ere are )Tj 1 0 0 1 34.32001 219.23 Tm (suitable arrangements for controlled drugs and any medicines requiring c\ old-storage.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (Records are kept of medicines received into the home, and of any unwante\ d medicines )Tj 1 0 0 1 34.32001 166.73999 Tm (that are sent for destruction. Records are kept of medicines that are gi\ ven to people, )Tj 1 0 0 1 34.32001 149.23999 Tm (which helps to show that people receive their medicines as prescribed by\ the doctor. If )Tj 1 0 0 1 34.32001 131.75 Tm (a regularly prescribed dose is omitted, then a reason for this is record\ ed, as is good )Tj 1 0 0 1 34.32001 114.25 Tm (practice. Usually if a variable dose is prescribed there are clear recor\ ds to show how )Tj 1 0 0 1 34.32001 96.75 Tm (much is given, and this too is good practice.)Tj ET endstream endobj 1007 0 obj 4862 endobj 1008 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 686.21997 w 34.60001 468.30002 m 562.53998 468.30002 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 664.84998 w 33.47 456.47998 m 563.65997 456.47998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 121.86 l S 564.78998 791.10999 m 564.78998 121.86 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 122.93001 m 565.87 122.93001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We looked at some people's care plans to see what information is recorde\ d about their )Tj 1 0 0 1 34.32001 744.10999 Tm (medicines. We found written permission from the doctor to crush someone'\ s tablets )Tj 1 0 0 1 34.32001 726.60999 Tm (before giving. Staff had not asked if other forms of the same medicines \ are available, )Tj 1 0 0 1 34.32001 709.10999 Tm (such as soluble tablets or liquids, to make it easier for people to take\ . We found clear )Tj 1 0 0 1 34.32001 691.62 Tm (guidance for staff on when to administer medication that was prescribed \ to be given )Tj 1 0 0 1 34.32001 674.12 Tm ('when required'. This helps to show that people receive their medicines \ in the way )Tj 1 0 0 1 34.32001 656.63 Tm (their doctor intended for them.)Tj 1 0 0 1 34.32001 639.13 Tm (\240)Tj 1 0 0 1 34.32001 621.63 Tm (We looked at how people's privacy and dignity is maintained. We heard pe\ ople being )Tj 1 0 0 1 34.32001 604.14001 Tm (called by their preferred names and some people were able to tell us the\ y wear their )Tj 1 0 0 1 34.32001 586.64001 Tm (own clothes. We saw staff discreetly helping some people go to the toile\ t. However, )Tj 1 0 0 1 34.32001 569.14996 Tm (we also saw one person trying to attract the attention of staff who walk\ ed past or said )Tj 1 0 0 1 34.32001 551.64996 Tm ('hang on' as they walked past and did not come back. We heard one person\ saying no )Tj 1 0 0 1 34.32001 534.14996 Tm (repeatedly and we heard a carer saying 'yes, yes, yes' in a mocking fash\ ion.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We saw in the care plans of two people that they like to be or are washe\ d, shaved, )Tj 1 0 0 1 34.32001 481.66998 Tm (have their hair brushed and dressed whilst sitting on the commode. This \ is not a )Tj 1 0 0 1 34.32001 464.16998 Tm (dignified way to provide care. In addition a record of names of people w\ ho had taken )Tj 1 0 0 1 34.32001 446.66998 Tm (a bath is kept in the communal bathroom. This indicates an institutional\ approach to )Tj 1 0 0 1 34.32001 429.17999 Tm (people's personal care needs and to their confidentiality.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (We saw one person being hoisted to be taken to the toilet. When raised o\ ut of their )Tj 1 0 0 1 34.32001 376.69 Tm (seat there was a strong smell of urine. After they left the lounge, the \ smell persisted. )Tj 1 0 0 1 34.32001 359.19 Tm (We smelt the chair and found that the smell was coming from the fabric o\ f the chair, )Tj 1 0 0 1 34.32001 341.70001 Tm (and from the pressure relieving cushion on the chair. When staff returne\ d they put )Tj 1 0 0 1 34.32001 324.20001 Tm (this person back onto the chair. Each time this person shifted their wei\ ght in their )Tj 1 0 0 1 34.32001 306.70999 Tm (chair, there was an unpleasant odour of stale urine released.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj 1 0 0 1 34.32001 271.70999 Tm (We saw that two people share a bedroom. There are no records to show tha\ t each )Tj 1 0 0 1 34.32001 254.22 Tm (person has been consulted or made an informed choice about this, as shou\ ld happen. )Tj 1 0 0 1 34.32001 236.72 Tm (We saw that the room can be divided by a curtain. When we asked one pers\ on if this )Tj 1 0 0 1 34.32001 219.23 Tm (was used, they told us that it isn't always. Although this person says t\ hey don't mind, )Tj 1 0 0 1 34.32001 201.73 Tm (it is unclear what the other person sharing this room thinks or feels ab\ out this as they )Tj 1 0 0 1 34.32001 184.23 Tm (have communication difficulties.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (One health care professional commented that sometimes shared rooms creat\ e )Tj 1 0 0 1 34.32001 131.75 Tm (problems around privacy and dignity. )Tj ET endstream endobj 1009 0 obj 5858 endobj 1010 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 437.25 m 562.53998 437.25 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 119.35001 w 33.47 426 m 563.65997 426 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 364.12 l S 564.78998 487.87988 m 564.78998 364.12 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 365.20001 m 565.87 365.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Some people's quality of life is enhanced by continued links with their \ families and )Tj 1 0 0 1 36.62 409.25 Tm (friends and by the activities they take part in. However, not everyone i\ s having their )Tj 1 0 0 1 36.62 391.75998 Tm (individual social needs and rights to make choices met.)Tj 1 0 0 1 36.62 374.25998 Tm (People enjoy an appetising, balanced diet that meets their nutritional n\ eeds.)Tj 1 0 0 1 28.35001 349.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 257.30002 w 34.60001 210.67998 m 562.53998 210.67998 l S 1 1 1 RG 22.5 w 32.35001 330.32999 m 564.78998 330.32999 l S 235.92998 w 33.47 198.87 m 563.65997 198.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 317.95999 m 565.87 317.95999 l S 32.35001 319.03998 m 32.35001 78.70001 l S 564.78998 319.03998 m 564.78998 78.70001 l S 32.35001 317.95999 m 564.78998 317.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 327.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 302.26999 Tm (Since the last inspection the home has employed an activities co-ordinat\ or for 20 )Tj 1 0 0 1 36.57001 284.78 Tm (hours each week. This person is responsible for meeting the social needs\ of all the )Tj 1 0 0 1 36.57001 267.28 Tm (people living here and provides support with helping people to eat and w\ ith personal )Tj 1 0 0 1 36.57001 249.78998 Tm (care such as cutting people's nails.)Tj 1 0 0 1 36.57001 232.28998 Tm (\240)Tj 1 0 0 1 36.57001 214.78998 Tm (In surveys people told us there are usually activities they can take par\ t in if they want )Tj 1 0 0 1 36.57001 197.3 Tm (to. We saw that about 4 people who spend their time in the lounge are we\ ll attended )Tj 1 0 0 1 36.57001 179.8 Tm (to. We saw people took part in a picture quiz, in card games and in phys\ ical activity. )Tj 1 0 0 1 36.57001 162.31 Tm (These people were having fun, were being included, were relaxed and were\ treated )Tj 1 0 0 1 36.57001 144.81 Tm (with respect and with warmth. We saw that one person in particular is re\ ally )Tj 1 0 0 1 36.57001 127.31 Tm (benefiting from having this social interaction.)Tj 1 0 0 1 36.57001 109.82001 Tm (\240)Tj 1 0 0 1 36.57001 92.32001 Tm (We also saw the the lounge is laid out in such a way that separate areas\ have been )Tj ET endstream endobj 1011 0 obj 4934 endobj 1012 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (created. This means that people can take part in different activities or\ have )Tj 1 0 0 1 34.32001 761.60004 Tm (conversations without disturbing anyone else, and away from the televisi\ on. The )Tj 1 0 0 1 34.32001 744.10999 Tm (television was on throughout the day during this inspection. It was set \ to a very high )Tj 1 0 0 1 34.32001 726.60999 Tm (volume and no one was watching it. One person did take an interest when \ the )Tj 1 0 0 1 34.32001 709.10999 Tm (lunchtime news came on. They told us they like to hear the news, but tha\ t they're not )Tj 1 0 0 1 34.32001 691.62 Tm (bothered otherwise.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We saw one person enjoying knitting who also benefited from the activiti\ es organised. )Tj 1 0 0 1 34.32001 639.13 Tm (Other people were invited to join in and declined or were unable to do s\ o due to their )Tj 1 0 0 1 34.32001 621.63 Tm (disabilities.)Tj 1 0 0 1 34.32001 604.14001 Tm (\240)Tj 1 0 0 1 34.32001 586.64001 Tm (Other people living in this home spend time in their rooms. We spoke wit\ h staff about )Tj 1 0 0 1 34.32001 569.14996 Tm (how these people are supported to have their social needs met. We were t\ old the )Tj 1 0 0 1 34.32001 551.64996 Tm (activities co-ordinator spends time with these people in their rooms. We\ found that, )Tj 1 0 0 1 34.32001 534.14996 Tm (whilst well intentioned and very skillful, this person cannot meet the s\ ocial needs of all )Tj 1 0 0 1 34.32001 516.65997 Tm (the people living here. People who are physically or mentally disabled s\ pend long )Tj 1 0 0 1 34.32001 499.16 Tm (periods alone.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (One person told us they get bored lying in bed all day. Their relative s\ aid that staff )Tj 1 0 0 1 34.32001 446.66998 Tm (come into the room, but that this is to carry out care tasks such as tur\ ning. The care )Tj 1 0 0 1 34.32001 429.17999 Tm (plan for this person does not contain any information about their intere\ sts or religious )Tj 1 0 0 1 34.32001 411.67999 Tm (or spiritual needs.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Other care plans contain some information about people's interests. Howe\ ver, )Tj 1 0 0 1 34.32001 359.19 Tm (knowledge about these interests is not being used to meet each person's \ need to be )Tj 1 0 0 1 34.32001 341.70001 Tm (engaged and be social in an individualised way.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (For example each care plan has sections about people's spiritual needs. \ The care plan )Tj 1 0 0 1 34.32001 289.20999 Tm (of one person who has dementia states they are very religious and identi\ fies their )Tj 1 0 0 1 34.32001 271.70999 Tm (religion. The care plan section relating to social needs records that th\ is person loves to )Tj 1 0 0 1 34.32001 254.22 Tm (go out. The care plan does not identify how this person will be supporte\ d to attend a )Tj 1 0 0 1 34.32001 236.72 Tm (religious service or how they will be helped to go out. Staff tell us th\ is person does not )Tj 1 0 0 1 34.32001 219.23 Tm (go to church and does not go out. In addition, the part of the care plan\ relating to )Tj 1 0 0 1 34.32001 201.73 Tm (people's death and dying needs states that this person should be encoura\ ged to )Tj 1 0 0 1 34.32001 184.23 Tm (express their wishes regarding death as it approaches. This statement is\ used in all )Tj 1 0 0 1 34.32001 166.73999 Tm (the care plans we looked at where the section on death and dying had bee\ n )Tj 1 0 0 1 34.32001 149.23999 Tm (completed. This person's plan makes no mention of the arrangements this \ person )Tj 1 0 0 1 34.32001 131.75 Tm (might like in relation to their religion.)Tj 1 0 0 1 34.32001 114.25 Tm (\240)Tj 1 0 0 1 34.32001 96.75 Tm (Another person's care plan does not identify their social interests and \ we saw that this )Tj ET endstream endobj 1013 0 obj 5000 endobj 1014 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (person spent the day at the home in the lounge without being engaged in \ any activity.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We asked staff how decisions are made about who gets up early or late. S\ taff told us )Tj 1 0 0 1 34.32001 726.60999 Tm ('the diabetics are always got up first and that after that it depends on\ where the )Tj 1 0 0 1 34.32001 709.10999 Tm (member of staff decides to start work'. This indicates that people are n\ ot offered )Tj 1 0 0 1 34.32001 691.62 Tm (choice.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We found that the care plan for one person contains a recently written s\ tatement that )Tj 1 0 0 1 34.32001 639.13 Tm (they like to get up at 6am. It also states that the nurse writing this h\ as discussed this )Tj 1 0 0 1 34.32001 621.63 Tm (with the person and that they agree with this. This person is described \ in the care plan )Tj 1 0 0 1 34.32001 604.14001 Tm (as having dementia and being confused. We found this statement in the ca\ re plan of )Tj 1 0 0 1 34.32001 586.64001 Tm (another person who is also described as having dementia. This means that\ people who )Tj 1 0 0 1 34.32001 569.14996 Tm (cannot speak up for themselves do not make decisions and do not have con\ trol over )Tj 1 0 0 1 34.32001 551.64996 Tm (their individual daily lives.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj 1 0 0 1 34.32001 516.65997 Tm (Visitors told us they can visit when they like. And we saw visitors in t\ he home at )Tj 1 0 0 1 34.32001 499.16 Tm (different times of the day and evening. Some people say that staff keep \ them up to )Tj 1 0 0 1 34.32001 481.66998 Tm (date with changes and developments and others say that staff don't do th\ is.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (In surveys people told us they always like the food served in the home. \ People we )Tj 1 0 0 1 34.32001 429.17999 Tm (spoke with say they like the variety and the quality of food served. We \ heard staff )Tj 1 0 0 1 34.32001 411.67999 Tm (asking people what they would like for lunch, close to the time this was\ being served. )Tj 1 0 0 1 34.32001 394.19 Tm (This means that people are helped to make a choice about what to eat at \ a time when )Tj 1 0 0 1 34.32001 376.69 Tm (they are ready to make this decision and when it means something to them\ . We were )Tj 1 0 0 1 34.32001 359.19 Tm (unsure how staff helped people who cannot speak for themselves to make d\ ecisions )Tj 1 0 0 1 34.32001 341.70001 Tm (about what to eat. We asked a member of care staff who told us that they\ get to know )Tj 1 0 0 1 34.32001 324.20001 Tm (what people like. We saw in care plans that there are records about some\ people's )Tj 1 0 0 1 34.32001 306.70999 Tm (likes and dislikes, but not for all people. We saw records relating to w\ hat one person )Tj 1 0 0 1 34.32001 289.20999 Tm (eats. We saw that they have porridge for breakfast every day as far back\ as we saw )Tj 1 0 0 1 34.32001 271.70999 Tm (records for \(approximately 11 weeks\). They had also had scrambled egg \ for supper for )Tj 1 0 0 1 34.32001 254.22 Tm (the majority of those 11 weeks. Staff told us that this person sometimes\ does not eat )Tj 1 0 0 1 34.32001 236.72 Tm (much at supper and on the day of this inspection staff told us this pers\ on only ate 2 )Tj 1 0 0 1 34.32001 219.23 Tm (small spoonfuls of supper. The records and conversations with staff do n\ ot indicate )Tj 1 0 0 1 34.32001 201.73 Tm (that staff had explored the possibility that this person might be bored \ with their )Tj 1 0 0 1 34.32001 184.23 Tm (supper diet.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We heard that one person who spends all their time in their bedroom had \ not had )Tj 1 0 0 1 34.32001 131.75 Tm (breakfast on two occasions and that their morning tea had been missed a \ couple of )Tj 1 0 0 1 34.32001 114.25 Tm (times.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 1015 0 obj 1224 endobj 1016 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We also saw two people being supported to eat by staff whilst in their b\ edrooms. The )Tj 1 0 0 1 34.32001 761.60004 Tm (support given was unhurried, relaxed and sensitive. )Tj ET endstream endobj 1017 0 obj 5679 endobj 1018 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 505.73999 m 562.53998 505.73999 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 84.36 w 33.47 494.5 m 563.65997 494.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 450.12 l S 564.78998 538.88 m 564.78998 450.12 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 451.19 m 565.87 451.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People concerns are not always acted upon and people are not fully safeg\ uarded from )Tj 1 0 0 1 36.62 460.25 Tm (harm. )Tj 1 0 0 1 28.35001 435.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 343.30002 w 34.60001 253.67 m 562.53998 253.67 l S 1 1 1 RG 22.5 w 32.35001 416.31998 m 564.78998 416.31998 l S 321.92999 w 33.47 241.86 m 563.65997 241.86 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 403.94998 m 565.87 403.94998 l S 32.35001 405.03 m 32.35001 78.70001 l S 564.78998 405.03 m 564.78998 78.70001 l S 32.35001 403.94998 m 564.78998 403.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 413.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 388.26999 Tm (In surveys all 3 people told us that they know how to make a formal comp\ laint and 2 )Tj 1 0 0 1 36.57001 370.76999 Tm (told us there is someone they can speak with informally if they are not \ happy. One )Tj 1 0 0 1 36.57001 353.26999 Tm (person said they can only do this with their visitors.)Tj 1 0 0 1 36.57001 335.78 Tm (\240)Tj 1 0 0 1 36.57001 318.28 Tm (The information given to us in the AQAA tells us that this home has rece\ ived one )Tj 1 0 0 1 36.57001 300.78998 Tm (complaint since the last inspection a year ago. This was dealt with by t\ he home within )Tj 1 0 0 1 36.57001 283.29001 Tm (28 days, which is the timescale set, and it was upheld. It also tells us\ that one )Tj 1 0 0 1 36.57001 265.79001 Tm (safeguarding alert was made alleging that someone living at the home was\ not )Tj 1 0 0 1 36.57001 248.3 Tm (receiving care that was safe. This was investigated by the safeguarding \ team in May )Tj 1 0 0 1 36.57001 230.8 Tm (2009. The outcome of this was that the care provided was not neglectful \ or abusive, )Tj 1 0 0 1 36.57001 213.31 Tm (but was poor practice.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Since then the commission has received two complaints about the quality \ of care, )Tj 1 0 0 1 36.57001 160.81999 Tm (about staff not being available when needed, about the management of med\ icines and )Tj 1 0 0 1 36.57001 143.31999 Tm (about the general management of the home. One person said they had bough\ t their )Tj 1 0 0 1 36.57001 125.83 Tm (concerns to the attention of staff but did not get a satisfactory respon\ se. Another )Tj 1 0 0 1 36.57001 108.33 Tm (person said they thought that staff were not taking their concerns serio\ usly enough.)Tj 1 0 0 1 36.57001 90.83 Tm (\240)Tj ET endstream endobj 1019 0 obj 5335 endobj 1020 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We have looked at some of these issues during this inspection and are wo\ rking with )Tj 1 0 0 1 34.32001 761.60004 Tm (the safeguarding team who are undertaking an investigation relating to t\ hese )Tj 1 0 0 1 34.32001 744.10999 Tm (allegations. In addition Devon County Council are reviewing the care of \ the people )Tj 1 0 0 1 34.32001 726.60999 Tm (living here.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (The AQAA tells us that no one living here is subject to any form of rest\ raint. However, )Tj 1 0 0 1 34.32001 674.12 Tm (a referral was made under the Deprivation of Liberty and Mental Capacity\ Act because )Tj 1 0 0 1 34.32001 656.63 Tm (one person is being restrained in their wheelchair. This is not a depriv\ ation of liberty )Tj 1 0 0 1 34.32001 639.13 Tm (but is a form of restraint. We saw that this continues. We also saw in a\ care plan that )Tj 1 0 0 1 34.32001 621.63 Tm (another person is restrained in their chair by using a lap belt when the\ y try to stand )Tj 1 0 0 1 34.32001 604.14001 Tm (up. We saw that people have bed rails whilst in their beds, which is ano\ ther form of )Tj 1 0 0 1 34.32001 586.64001 Tm (restraint. There is some indication that the restraint used for people w\ hilst sitting in )Tj 1 0 0 1 34.32001 569.14996 Tm (their chairs might not always be appropriate. This is because records st\ ate that it is )Tj 1 0 0 1 34.32001 551.64996 Tm (used when people try to stand up or get agitated. The use of restraint i\ s sometimes )Tj 1 0 0 1 34.32001 534.14996 Tm (the only action that can be taken to keep someone safe. However, records\ should )Tj 1 0 0 1 34.32001 516.65997 Tm (show that all other actions to reduce risk have been tried before this a\ ction is taken. )Tj 1 0 0 1 34.32001 499.16 Tm (In addition, care plans do not give clear and specific instructions as t\ o when restraint )Tj 1 0 0 1 34.32001 481.66998 Tm (should be used and for how long. We asked staff about the use of restrai\ nt in the form )Tj 1 0 0 1 34.32001 464.16998 Tm (of a lap belt for one person. They told us that they use it only when ne\ eded, when )Tj 1 0 0 1 34.32001 446.66998 Tm (staff are not around, and for a few hours. This means that restraint is \ being used for )Tj 1 0 0 1 34.32001 429.17999 Tm (long periods when staff are not around to supervise vulnerable and agita\ ted people.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (People who live here are having decisions about forms of restraint made \ by staff or )Tj 1 0 0 1 34.32001 376.69 Tm (relatives. Sometimes this has to happen if the person involved is not ab\ le to make )Tj 1 0 0 1 34.32001 359.19 Tm (these decisions for themselves. The circumstances of these decisions sho\ uld be )Tj 1 0 0 1 34.32001 341.70001 Tm (recorded so that it is clear that these decisions are being made in the \ best interests of )Tj 1 0 0 1 34.32001 324.20001 Tm (that person. Such records are not being kept for people living in this h\ ome.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We saw three people who have bruises or broken skin. We asked staff abou\ t these. )Tj 1 0 0 1 34.32001 271.70999 Tm (They gave us explanations for two but staff did not know what had caused\ the third )Tj 1 0 0 1 34.32001 254.22 Tm (injury. We saw in care records that one person's injury had been caused \ when they )Tj 1 0 0 1 34.32001 236.72 Tm (had resisted care. The circumstances of this have not been investigated \ and actions )Tj 1 0 0 1 34.32001 219.23 Tm (have not been taken to prevent this happening again. Another person inju\ red them )Tj 1 0 0 1 34.32001 201.73 Tm (self on a bed rail and there are no records to show that actions have be\ en taken to )Tj 1 0 0 1 34.32001 184.23 Tm (prevent this happening again.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We spoke with staff about what they would do if they saw or suspected ab\ use. They )Tj 1 0 0 1 34.32001 131.75 Tm (told us they would tell the nurse in charge, as is good practice. We ask\ ed the nurse in )Tj 1 0 0 1 34.32001 114.25 Tm (charge what they would do, and the actions they describe are contrary to\ the guidance )Tj 1 0 0 1 34.32001 96.75 Tm (given in the multi-agency guidance. This person told us that they had re\ ceived )Tj ET endstream endobj 1021 0 obj 1252 endobj 1022 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 56.36 w 34.60001 783.21997 m 562.53998 783.21997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 34.99001 w 33.47 771.40997 m 563.65997 771.40997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 751.70996 l S 564.78998 791.10999 m 564.78998 751.70996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 752.78998 m 565.87 752.78998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (training and had a copy of the guidance in the home. However, the guidan\ ce they )Tj 1 0 0 1 34.32001 761.60004 Tm (showed us would not guide them to take appropriate action if abuse were \ suspected. )Tj ET endstream endobj 1023 0 obj 5720 endobj 1024 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 488.73999 m 562.53998 488.73999 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 84.36 w 33.47 477.5 m 563.65997 477.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 433.12 l S 564.78998 521.88 m 564.78998 433.12 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 434.19 m 565.87 434.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (People living here enjoy a homely environment. However, improvements are\ needed )Tj 1 0 0 1 36.62 443.25 Tm (to ensure that people are fully protected from infection. )Tj 1 0 0 1 28.35001 418.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 326.30002 w 34.60001 245.17 m 562.53998 245.17 l S 1 1 1 RG 22.5 w 32.35001 399.31998 m 564.78998 399.31998 l S 304.92999 w 33.47 233.36 m 563.65997 233.36 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 386.94998 m 565.87 386.94998 l S 32.35001 388.03 m 32.35001 78.70001 l S 564.78998 388.03 m 564.78998 78.70001 l S 32.35001 386.94998 m 564.78998 386.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 396.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 371.26999 Tm (In surveys people told us that the home is usually clean and fresh. On t\ he day we )Tj 1 0 0 1 36.57001 353.76999 Tm (visited we found it to be clean and odour free.)Tj 1 0 0 1 36.57001 336.26999 Tm (\240)Tj 1 0 0 1 36.57001 318.78 Tm (The home is warm, and is furnished and decorated in a domestic and homel\ y style. )Tj 1 0 0 1 36.57001 301.28 Tm (There is a reception area in the large hall, where there is usually a me\ mber of staff )Tj 1 0 0 1 36.57001 283.79001 Tm (during the day so that people visiting the home can speak with them. The\ re is also a )Tj 1 0 0 1 36.57001 266.29001 Tm (large board in the hall displaying the photographs and names of the staf\ f working at )Tj 1 0 0 1 36.57001 248.78998 Tm (the home. This is helpful so that people can identify and become familia\ r with staff.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The home has one large lounge and a dining room. Both are decorated and \ furnished )Tj 1 0 0 1 36.57001 196.31 Tm (in a homely style. The tables in the dining room are smaller and this he\ lps people to )Tj 1 0 0 1 36.57001 178.81 Tm (sit in smaller groups and to experience meals as a social occasion. The \ lounge is )Tj 1 0 0 1 36.57001 161.31 Tm (divided into smaller seating areas so that people can carry out differen\ t activities )Tj 1 0 0 1 36.57001 143.81999 Tm (without disturbing others. This area is very bright as it has large wind\ ows to the side )Tj 1 0 0 1 36.57001 126.32001 Tm (and rear of the house.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (We saw staff washing their hands and wearing protective clothing as a wa\ y of helping )Tj ET endstream endobj 1025 0 obj 2517 endobj 1026 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (to prevent the spread of infection. Staff use alcohol gel as another way\ of preventing )Tj 1 0 0 1 34.32001 761.60004 Tm (the spread of infection, and this is also available for visitors to the \ home to use.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we saw that the sluice did not have liquid soap for staff to wa\ sh their hands, )Tj 1 0 0 1 34.32001 709.10999 Tm (and that some soap dispensers appear dirty and one was empty.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last inspection by the commission the home have also been visi\ ted by the )Tj 1 0 0 1 34.32001 656.63 Tm (fire authority. Some actions were required and these have been carried o\ ut. We saw )Tj 1 0 0 1 34.32001 639.13 Tm (that access from the home is controlled at the front door by a key pad s\ ystem and )Tj 1 0 0 1 34.32001 621.63 Tm (were told that this is linked to the fire alarm. This means that when th\ e fire alarm )Tj 1 0 0 1 34.32001 604.14001 Tm (sounds that the door lock will automatically be opened, and is good prac\ tice.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We were told that some areas of the home have been redecorated. We saw o\ ne )Tj 1 0 0 1 34.32001 551.64996 Tm (upstairs window being replaced. We saw that staff test and record the te\ mperature of )Tj 1 0 0 1 34.32001 534.14996 Tm (bathing water as is good practice to ensure that accidental scalding is \ prevented. )Tj ET endstream endobj 1027 0 obj 5784 endobj 1028 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 480 m 562.53998 480 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 101.85001 w 33.47 468.75 m 563.65997 468.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 415.62 l S 564.78998 521.88 m 564.78998 415.62 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 416.70001 m 565.87 416.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (There are not always enough staff on duty with the appropriate qualifica\ tions, training )Tj 1 0 0 1 36.62 443.25 Tm (and skills to care for people living here. Practices in relation to recr\ uitment are placing )Tj 1 0 0 1 36.62 425.75998 Tm (people at risk of harm. )Tj 1 0 0 1 28.35001 401.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 308.80002 w 34.60001 236.42998 m 562.53998 236.42998 l S 1 1 1 RG 22.5 w 32.35001 381.82999 m 564.78998 381.82999 l S 287.42999 w 33.47 224.62 m 563.65997 224.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 369.44998 m 565.87 369.44998 l S 32.35001 370.53 m 32.35001 78.70001 l S 564.78998 370.53 m 564.78998 78.70001 l S 32.35001 369.44998 m 564.78998 369.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 378.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 353.76999 Tm (This is a nursing home and should have a registered nurse on duty throug\ hout the day )Tj 1 0 0 1 36.57001 336.26999 Tm (and night. We were contacted by a person who was concerned this was not \ )Tj 1 0 0 1 36.57001 318.78 Tm (happening. We contacted the home and it was confirmed that on one night \ there was )Tj 1 0 0 1 36.57001 301.28 Tm (not a nurse on duty. We asked the owner why they had not used an agency \ nurse to )Tj 1 0 0 1 36.57001 283.79001 Tm (cover this shift. They told us that this home never uses agency staff. T\ hey told us that )Tj 1 0 0 1 36.57001 266.29001 Tm (due to staff sickness they had arranged for a nurse to sleep at the home\ on that night. )Tj 1 0 0 1 36.57001 248.78998 Tm (This practice puts people at risk.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (The caller was also concerned that there are not enough staff on duty. W\ e spoke to )Tj 1 0 0 1 36.57001 196.31 Tm (the owner about this. She told us that staffing has been reduced but tha\ t there are )Tj 1 0 0 1 36.57001 178.81 Tm (enough staff on duty to meet people's current needs. We looked at the du\ ty rota and )Tj 1 0 0 1 36.57001 161.31 Tm (saw that there had previously been 3 or 4 carers on duty in the morning \ and this had )Tj 1 0 0 1 36.57001 143.81999 Tm (been reduced to 2 or 3 carers. In the afternoon we saw that there used t\ o be 2 or 3 )Tj 1 0 0 1 36.57001 126.32001 Tm (carers on duty in the afternoon, and now there are 2. On the day of this\ inspection )Tj 1 0 0 1 36.57001 108.83 Tm (there was a nurse on duty with 3 carers, an administrator, cook and the \ temporary )Tj 1 0 0 1 36.57001 91.33 Tm (manager.)Tj ET endstream endobj 1029 0 obj 4923 endobj 1030 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (We saw in the information given to us by the home prior to the inspectio\ n that there )Tj 1 0 0 1 34.32001 744.10999 Tm (are 14 people living at the home who need help with undressing and dress\ ing, and )Tj 1 0 0 1 34.32001 726.60999 Tm (need help to go to the toilet. 11 people are incontinent of both faeces \ and urine and 8 )Tj 1 0 0 1 34.32001 709.10999 Tm (people have dementia. 11 people need two members of staff to help them w\ ith their )Tj 1 0 0 1 34.32001 691.62 Tm (care.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (In surveys one person told us that staff are usually available, one that\ staff are )Tj 1 0 0 1 34.32001 639.13 Tm (sometimes available and one that staff are never available when needed. \ Comments )Tj 1 0 0 1 34.32001 621.63 Tm (included staff are not always available, and the home is very short of s\ taff. The )Tj 1 0 0 1 34.32001 604.14001 Tm (surveys also asked what the home could do better. People said employ mor\ e staff who )Tj 1 0 0 1 34.32001 586.64001 Tm (can speak and understand English and train and employ more staff especia\ lly at night. )Tj 1 0 0 1 34.32001 569.14996 Tm (Staff were however described as nice and lovely.)Tj 1 0 0 1 34.32001 551.64996 Tm (\240)Tj 1 0 0 1 34.32001 534.14996 Tm (We looked at the records relating to falls and injuries. According to th\ ese records )Tj 1 0 0 1 34.32001 516.65997 Tm (people have been found to have fallen when there have been no staff pres\ ent on 14 )Tj 1 0 0 1 34.32001 499.16 Tm (separate occasions since the beginning of July this year. This means tha\ t people are )Tj 1 0 0 1 34.32001 481.66998 Tm (not being sufficiently supervised by staff to keep them safe.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We know that these accident records are incomplete. We are aware that on\ e person )Tj 1 0 0 1 34.32001 429.17999 Tm (has fallen whilst alone, and this is not recorded. We also saw that two \ people had )Tj 1 0 0 1 34.32001 411.67999 Tm (injuries which have not been recorded as accidents or incidents.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We looked at the duty rota and found that is is not always accurate. For\ example, on )Tj 1 0 0 1 34.32001 359.19 Tm (some weeks the manager, who has left the home, is recorded as on duty. I\ n addition, )Tj 1 0 0 1 34.32001 341.70001 Tm (the temporary manager has not been included on the duty rota until Septe\ mber )Tj 1 0 0 1 34.32001 324.20001 Tm (although they say they started work at the home in August.)Tj 1 0 0 1 34.32001 306.70999 Tm (\240)Tj 1 0 0 1 34.32001 289.20999 Tm (We asked to see the records of staff training. We were told that these a\ re incomplete )Tj 1 0 0 1 34.32001 271.70999 Tm (because the records about training have gone missing since the manager l\ eft the )Tj 1 0 0 1 34.32001 254.22 Tm (home. We saw that some records had been made about training, but that th\ ere were )Tj 1 0 0 1 34.32001 236.72 Tm (large gaps. The management team tell us that this means they are not ful\ ly aware of )Tj 1 0 0 1 34.32001 219.23 Tm (what training staff have had, and what training might be needed. We did \ see a notice )Tj 1 0 0 1 34.32001 201.73 Tm (that said that training has been arranged for staff in relation preventi\ ng people from )Tj 1 0 0 1 34.32001 184.23 Tm (falling.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (Staff told us they had had some training. One told us they had had train\ ing in how to )Tj 1 0 0 1 34.32001 131.75 Tm (provide care to people, another that they thought they had had training \ in relation to )Tj 1 0 0 1 34.32001 114.25 Tm (supporting people who have problems with swallowing. However, they went \ on to )Tj 1 0 0 1 34.32001 96.75 Tm (describe training which relates to nutritional supplements. One person t\ hought they )Tj ET endstream endobj 1031 0 obj 2380 endobj 1032 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 266.32001 w 34.60001 678.25 m 562.53998 678.25 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 244.93999 w 33.47 666.44 m 563.65997 666.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 541.76001 l S 564.78998 791.10999 m 564.78998 541.76001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 542.83997 m 565.87 542.83997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (had had training about dementia, and gave a description of how to care f\ or someone )Tj 1 0 0 1 34.32001 761.60004 Tm (with dementia which was an example of good practice.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (However, we also saw that staff record that people have drunk more than \ they have. )Tj 1 0 0 1 34.32001 709.10999 Tm (We heard staff trying to persuade a confused person that their understan\ ding of a )Tj 1 0 0 1 34.32001 691.62 Tm (situation was wrong, causing distress and confusion to this person. We a\ lso saw staff )Tj 1 0 0 1 34.32001 674.12 Tm (ignoring one person who was trying to attract their attention.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (The AQAA told us that 10 of the 12 carers working at this home have achi\ eved a )Tj 1 0 0 1 34.32001 621.63 Tm (National Vocational Qualification \(NVQ\) in care, to level 2 or above. \ We asked the )Tj 1 0 0 1 34.32001 604.14001 Tm (manager if there is a system in place to ensure that staff practice the \ skills they are )Tj 1 0 0 1 34.32001 586.64001 Tm (taught, and to ensure they do this to the level of quality that is expec\ ted. The )Tj 1 0 0 1 34.32001 569.14996 Tm (manager told us that this is the nurses responsibility and that there is\ no formal )Tj 1 0 0 1 34.32001 551.64996 Tm (system.)Tj ET endstream endobj 1033 0 obj 5831 endobj 1034 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 395 m 562.53998 395 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 101.85001 w 33.47 383.75 m 563.65997 383.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 330.62 l S 564.78998 436.88 m 564.78998 330.62 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 331.70001 m 565.87 331.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of leadership in this home means that systems are not in place to e\ nsure that )Tj 1 0 0 1 36.62 358.25 Tm (people receive the care they need to an acceptable standard in a way tha\ t promotes )Tj 1 0 0 1 36.62 340.75998 Tm (their safety. )Tj 1 0 0 1 28.35001 316.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.8 w 34.60001 193.92999 m 562.53998 193.92999 l S 1 1 1 RG 22.5 w 32.35001 296.82999 m 564.78998 296.82999 l S 202.42998 w 33.47 182.12 m 563.65997 182.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 284.44998 m 565.87 284.44998 l S 32.35001 285.53 m 32.35001 78.70001 l S 564.78998 285.53 m 564.78998 78.70001 l S 32.35001 284.44998 m 564.78998 284.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.76999 Tm (This home does not have a Registered Manager. The previous manager left \ in August )Tj 1 0 0 1 36.57001 251.26999 Tm (2009. Since that time the home has been managed on a temporary basis. Th\ e )Tj 1 0 0 1 36.57001 233.78 Tm (temporary manager is a Registered Nurse and is studying for a Leadership\ and )Tj 1 0 0 1 36.57001 216.28 Tm (Management qualification. She had been working as the \(unregistered\) m\ anager of )Tj 1 0 0 1 36.57001 198.78998 Tm (the owners' residential home, and works from 9am - 3pm four days weekly.\ She is )Tj 1 0 0 1 36.57001 181.28998 Tm (supernumerary to nursing hours and is supported by two of the four owner\ s of this )Tj 1 0 0 1 36.57001 163.78999 Tm (home, who are also nurses.)Tj 1 0 0 1 36.57001 146.3 Tm (\240)Tj 1 0 0 1 36.57001 128.8 Tm (In the last few months the commission has received comments from relativ\ es of )Tj 1 0 0 1 36.57001 111.31 Tm (people living here who say the overall management of the home has declin\ ed. One )Tj 1 0 0 1 36.57001 93.81 Tm (person described the management as chaotic, saying that this has resulte\ d in people )Tj ET endstream endobj 1035 0 obj 5070 endobj 1036 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (not getting the care they need.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked to see if there are systems in place to ensure the home runs e\ fficiently and )Tj 1 0 0 1 34.32001 726.60999 Tm (safely, and that people get the care they need. We found that systems ar\ e not robust )Tj 1 0 0 1 34.32001 709.10999 Tm (enough to achieve this.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (For example we looked at the system for communicating peoples' needs and\ changing )Tj 1 0 0 1 34.32001 656.63 Tm (needs, and for ensuring that peoples' needs are met. The owners and mana\ ger told us )Tj 1 0 0 1 34.32001 639.13 Tm (that this is achieved through the care planning system. However, we foun\ d that these )Tj 1 0 0 1 34.32001 621.63 Tm (documents are complex and contradictory in places. They do not always pr\ ovide the )Tj 1 0 0 1 34.32001 604.14001 Tm (level of detail needed by staff to ensure that they have the information\ they need, and )Tj 1 0 0 1 34.32001 586.64001 Tm (to ensure that people's needs are met in a way that is consistent and of\ a satisfactory )Tj 1 0 0 1 34.32001 569.14996 Tm (quality. We found that reviews of people's care do not include all the i\ nformation )Tj 1 0 0 1 34.32001 551.64996 Tm (available and do not always provide evidence for some of the care decisi\ ons made )Tj 1 0 0 1 34.32001 534.14996 Tm (\(see Health and Personal Care\). Care staff told us they do not read ca\ re plans. We )Tj 1 0 0 1 34.32001 516.65997 Tm (asked if they got a hand over of information at the beginning of each sh\ ift and they )Tj 1 0 0 1 34.32001 499.16 Tm (told us they do not. We asked the manager how information is relayed to \ staff. She )Tj 1 0 0 1 34.32001 481.66998 Tm (told us that she expects the nurses to do this. The evidence in the Heal\ th and Personal )Tj 1 0 0 1 34.32001 464.16998 Tm (Care section of this report, shows that this is not happening.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We looked closely at how some decisions about people's care are made. Fo\ r example, )Tj 1 0 0 1 34.32001 411.67999 Tm (one record states that one person cannot make a decision about having be\ d rails on )Tj 1 0 0 1 34.32001 394.19 Tm (their bed. However, records show that this person has made a decision ab\ out having )Tj 1 0 0 1 34.32001 376.69 Tm (repeated invasive procedures. Another person can make the decision to ge\ t up at 6am )Tj 1 0 0 1 34.32001 359.19 Tm (but cannot make a decision about what they eat.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at how risks in the home are managed. We found that people are\ identified )Tj 1 0 0 1 34.32001 306.70999 Tm (as being at risk of falling. Care records instruct staff to observe them\ . Records show )Tj 1 0 0 1 34.32001 289.20999 Tm (that a lot of falls have happened to people when staff are not present. \ Although there )Tj 1 0 0 1 34.32001 271.70999 Tm (is a system for recording this information, there is not a system for mo\ nitoring and )Tj 1 0 0 1 34.32001 254.22 Tm (analysing this information, and therefore actions have not been taken to\ help prevent )Tj 1 0 0 1 34.32001 236.72 Tm (and reduce the number of falls.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (We looked to see if there is a safe system in place for moving and handl\ ing people )Tj 1 0 0 1 34.32001 184.23 Tm (with mobility problems. We found that assessments have not been carried \ out or had )Tj 1 0 0 1 34.32001 166.73999 Tm (been carried out a long time ago and have not been reviewed. We found th\ at decisions )Tj 1 0 0 1 34.32001 149.23999 Tm (about the type of equipment to be used are based on the equipment that i\ s available )Tj 1 0 0 1 34.32001 131.75 Tm (and not on what would be the most suitable for each person. The manager \ reports )Tj 1 0 0 1 34.32001 114.25 Tm (that staff have not had training in how to carry out moving and handling\ assessments.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 1037 0 obj 5058 endobj 1038 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We looked at how other risks in the home have been managed. We found tha\ t the )Tj 1 0 0 1 34.32001 761.60004 Tm (temperature of hot water is restricted to help ensure that people are no\ t scalded. We )Tj 1 0 0 1 34.32001 744.10999 Tm (found that windows have restricted openings to prevent people falling. H\ owever, we )Tj 1 0 0 1 34.32001 726.60999 Tm (found one window, that had been replaced that day, did not have a restri\ cted opening. )Tj 1 0 0 1 34.32001 709.10999 Tm (We told one of the owners who told us they thought that it had been rest\ ricted since )Tj 1 0 0 1 34.32001 691.62 Tm (we last looked. When we looked again, it had not.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked in the kitchen and found it clean and tidy. The owners identif\ ied )Tj 1 0 0 1 34.32001 639.13 Tm (approximately 4 years ago that the kitchen is coming to the end of its u\ seful life, and )Tj 1 0 0 1 34.32001 621.63 Tm (the Environmental Health Officer also identified this. The cook reports \ that a )Tj 1 0 0 1 34.32001 604.14001 Tm (refurbishment date has not yet been set.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We looked at how equipment is maintained. We found that the weighing sca\ les had )Tj 1 0 0 1 34.32001 551.64996 Tm (been weighing inaccurately for some time meaning that people at risk of \ malnutrition )Tj 1 0 0 1 34.32001 534.14996 Tm (could not be weighed accurately. The lift broke down for at least 2 days\ in October.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We looked at how the home involve people in the running of the home and \ how the )Tj 1 0 0 1 34.32001 481.66998 Tm (management team get feedback from people and improve the quality of care\ given. )Tj 1 0 0 1 34.32001 464.16998 Tm (We were told by relatives that meetings are sometimes held to which they\ are invited. )Tj 1 0 0 1 34.32001 446.66998 Tm (One person told us at that at the last meeting they had been informed th\ ere were )Tj 1 0 0 1 34.32001 429.17999 Tm (going to be a lot of changes in the home. They asked for, and the manage\ ment team )Tj 1 0 0 1 34.32001 411.67999 Tm (agreed they could have, a list of these changes so that they could prepa\ re their parent )Tj 1 0 0 1 34.32001 394.19 Tm (for these changes. They have not received this.)Tj 1 0 0 1 34.32001 376.69 Tm (\240)Tj 1 0 0 1 34.32001 359.19 Tm (We looked at the results of the most recent quality assurance survey \(J\ une 2009\). )Tj 1 0 0 1 34.32001 341.70001 Tm (Some people had said they were not satisfied with the length of time it \ took to answer )Tj 1 0 0 1 34.32001 324.20001 Tm (call bells. One person said that new staff were not given enough trainin\ g meaning that )Tj 1 0 0 1 34.32001 306.70999 Tm (they had to take instruction from the person they were meant to be carin\ g for. Two )Tj 1 0 0 1 34.32001 289.20999 Tm (people thought that improvements should be made to laundry and one to ir\ oning. We )Tj 1 0 0 1 34.32001 271.70999 Tm (asked how these issues had been addressed and the owner did not know bec\ ause the )Tj 1 0 0 1 34.32001 254.22 Tm (survey was carried out when the previous manager was employed.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We checked to see if previous requirements set by the commission have be\ en met. )Tj 1 0 0 1 34.32001 201.73 Tm (We found that requirements relating to health and welfare, care planning\ , )Tj 1 0 0 1 34.32001 184.23 Tm (safeguarding people, meeting people's social needs, staff skills and imp\ roving the )Tj 1 0 0 1 34.32001 166.73999 Tm (overall management have not been met.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We did not check any personal allowance accounts of the people living he\ re as the )Tj 1 0 0 1 34.32001 114.25 Tm (home does not hold any money on behalf of people. Instead they run a deb\ it account, )Tj 1 0 0 1 34.32001 96.75 Tm (recording all monies spent on people's behalf. Records and receipts are \ given to )Tj ET endstream endobj 1039 0 obj 1648 endobj 1040 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (35)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (46)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 126.35001 w 34.60001 748.22998 m 562.53998 748.22998 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 104.98 w 33.47 736.41998 m 563.65997 736.41998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 681.72998 l S 564.78998 791.10999 m 564.78998 681.72998 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 682.81 m 565.87 682.81 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (relatives and supporters for them to check and to pay for retrospectivel\ y.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (During our inspection it came to light that the commission are not being\ notified of all )Tj 1 0 0 1 34.32001 726.60999 Tm (incidents that affect the welfare of people living here as they should b\ e. 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They )Tj 1 0 0 1 294.54999 448.95999 Tm (must record their findings )Tj 1 0 0 1 294.54999 434.38 Tm (and send these to the )Tj 1 0 0 1 294.54999 419.80002 Tm (commission after each visit.)Tj 1 0 0 1 294.54999 405.22 Tm (\240)Tj 1 0 0 1 294.54999 390.63998 Tm (Previous timescale of )Tj 1 0 0 1 294.54999 376.06 Tm (13/04/07 not met.)Tj 1 0 0 1 294.54999 361.47998 Tm (\240)Tj 1 0 0 1 294.54999 346.89999 Tm (Not inspected on this )Tj 1 0 0 1 294.54999 332.32001 Tm (occasion. 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This )Tj 1 0 0 1 298.04999 446.73999 Tm (assessment must include )Tj 1 0 0 1 298.04999 429.73999 Tm (health and social care )Tj 1 0 0 1 298.04999 412.73999 Tm (assessments if the )Tj 1 0 0 1 298.04999 395.73999 Tm (placement takes place )Tj 1 0 0 1 298.04999 378.73999 Tm (through health or social care )Tj 1 0 0 1 298.04999 361.73999 Tm (services. )Tj 1 0 0 1 298.04999 344.73999 Tm (\240)Tj 1 0 0 1 298.04999 327.73999 Tm (This will help to ensure that )Tj 1 0 0 1 298.04999 310.73999 Tm (each person's needs are )Tj 1 0 0 1 298.04999 293.73999 Tm (identified and can be met. )Tj 1 0 0 1 482.10001 514.73999 Tm (07/12/2009)Tj 1 0 0 1 554.04999 514.73999 Tm (\240)Tj 1 0 0 1 35.5 274.48999 Tm (2)Tj 1 0 0 1 99.3 274.48999 Tm (7)Tj 1 0 0 1 201.55 274.48999 Tm (15)Tj 1 0 0 1 298.04999 274.48999 Tm (You must ensure that care )Tj 1 0 0 1 298.04999 257.48999 Tm (plans provide clear and up )Tj 1 0 0 1 298.04999 240.48999 Tm (to date instructions on how )Tj 1 0 0 1 298.04999 223.48999 Tm (each person's care needs )Tj 1 0 0 1 298.04999 206.48999 Tm (are to be met, recorded and )Tj 1 0 0 1 298.04999 189.48999 Tm (monitored. Information )Tj 1 0 0 1 298.04999 172.48999 Tm (recorded in care plans must )Tj 1 0 0 1 298.04999 155.48999 Tm (be relevant and appropriate. )Tj 1 0 0 1 298.04999 138.48999 Tm (All parts of the care plan )Tj 1 0 0 1 298.04999 121.49001 Tm (must be reviewed and )Tj 1 0 0 1 298.04999 104.49001 Tm (updated as appropriate. All )Tj 1 0 0 1 298.04999 87.49001 Tm (irrelevant parts of the care )Tj 1 0 0 1 298.04999 70.49001 Tm (plan must be removed. )Tj 1 0 0 1 482.10001 274.48999 Tm (07/12/2009)Tj 1 0 0 1 554.04999 274.48999 Tm (\240)Tj ET endstream endobj 1049 0 obj 5324 endobj 1050 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (40)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj ET 0.95294 0.95294 0.95294 RG 732.78998 w 32.32001 445.00998 m 564.96997 445.00998 l S 1 1 1 RG 102 w 31.2 659.98999 m 91.05 659.98999 l S 93.3 659.98999 m 197.40001 659.98999 l S 199.64998 659.98999 m 289.44998 659.98999 l S 291.70001 659.98999 m 473.80002 659.98999 l S 476.04999 659.98999 m 566.10004 659.98999 l S 374 w 31.2 419.73999 m 91.05 419.73999 l S 93.3 419.73999 m 197.40001 419.73999 l S 199.64998 419.73999 m 289.44998 419.73999 l S 291.70001 419.73999 m 473.80002 419.73999 l S 476.04999 419.73999 m 566.10004 419.73999 l S 153 w 31.2 153.98999 m 91.05 153.98999 l S 93.3 153.98999 m 197.40001 153.98999 l S 199.64998 153.98999 m 289.44998 153.98999 l S 291.70001 153.98999 m 473.80002 153.98999 l S 476.04999 153.98999 m 566.10004 153.98999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 607.85999 m 568.29999 607.85999 l S 28.99001 231.61 m 568.29999 231.61 l S 30.07001 713.19 m 30.07001 75.29001 l S 567.21997 713.19 m 567.21997 75.29001 l S 28.99001 744.65997 m 568.40002 744.65997 l S 28.99001 712.10999 m 568.29999 712.10999 l S 92.17 713.19 m 92.17 75.29001 l S 198.51999 713.19 m 198.51999 75.29001 l S 290.57001 713.19 m 290.57001 75.29001 l S 474.91998 713.19 m 474.91998 75.29001 l S 28.99001 813.64996 m 568.40002 813.64996 l S 28.99001 744.65997 m 568.40002 744.65997 l S 28.99001 712.10999 m 568.40002 712.10999 l S 28.99001 607.85999 m 568.29999 607.85999 l S 28.99001 231.61 m 568.29999 231.61 l S 28.99001 76.36 m 568.29999 76.36 l S 30.07001 814.72998 m 30.07001 711.03998 l S 92.12 745.73999 m 92.12 711.03998 l S 198.51999 745.73999 m 198.51999 711.03998 l S 290.62 745.73999 m 290.62 711.03998 l S 475.01999 745.73999 m 475.01999 711.03998 l S 567.32001 814.72998 m 567.32001 711.03998 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 800.46997 Tm (Statutory requirements)Tj 0 Tr 1 0 0 1 34.05 780.46997 Tm (These requirements set out what the registered person must do to meet th\ e Care )Tj 1 0 0 1 34.05 765.88995 Tm (Standards Act 2000, Care Homes)Tj 1 0 0 1 239.76999 765.88995 Tm (Regulations 2001 and the National Minimum )Tj 1 0 0 1 34.05 751.31 Tm (Standards. 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They )Tj 1 0 0 1 298.04999 201.42998 Tm (must record their findings )Tj 1 0 0 1 298.04999 184.42999 Tm (and send these to the )Tj 1 0 0 1 298.04999 167.42999 Tm (commission after each visit. )Tj 1 0 0 1 482.10001 337.42999 Tm (07/12/2009)Tj 1 0 0 1 554.04999 337.42999 Tm (\240)Tj 1 0 0 1 35.5 148.17999 Tm (19)Tj 1 0 0 1 99.3 148.17999 Tm (38)Tj 1 0 0 1 201.55 148.17999 Tm (23)Tj 1 0 0 1 298.04999 148.17999 Tm (You must ensure that )Tj 1 0 0 1 298.04999 131.17999 Tm (equipment provided at the )Tj 1 0 0 1 298.04999 114.18001 Tm (home for use by people )Tj 1 0 0 1 298.04999 97.18001 Tm (living here is maintained in )Tj 1 0 0 1 298.04999 80.18001 Tm (good working order. )Tj 1 0 0 1 482.10001 148.17999 Tm (31/12/2009)Tj 1 0 0 1 554.04999 148.17999 Tm (\240)Tj ET endstream endobj 1059 0 obj 6422 endobj 1060 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (45)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (46)Tj ET 0.95294 0.95294 0.95294 RG 305.53998 w 32.32001 658.63 m 564.96997 658.63 l S 1 1 1 RG 68 w 31.2 676.98999 m 91.05 676.98999 l S 93.3 676.98999 m 197.40001 676.98999 l S 199.64998 676.98999 m 289.44998 676.98999 l S 291.70001 676.98999 m 473.80002 676.98999 l S 476.04999 676.98999 m 566.10004 676.98999 l S 136 w 31.2 572.73999 m 91.05 572.73999 l S 93.3 572.73999 m 197.40001 572.73999 l S 199.64998 572.73999 m 289.44998 572.73999 l S 291.70001 572.73999 m 473.80002 572.73999 l S 476.04999 572.73999 m 566.10004 572.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 641.85999 m 568.29999 641.85999 l S 30.07001 713.19 m 30.07001 502.53998 l S 567.21997 713.19 m 567.21997 502.53998 l S 28.99001 744.65997 m 568.40002 744.65997 l S 28.99001 712.10999 m 568.29999 712.10999 l S 92.17 713.19 m 92.17 502.53998 l S 198.51999 713.19 m 198.51999 502.53998 l S 290.57001 713.19 m 290.57001 502.53998 l S 474.91998 713.19 m 474.91998 502.53998 l S 28.99001 813.64996 m 568.40002 813.64996 l S 28.99001 744.65997 m 568.40002 744.65997 l S 28.99001 712.10999 m 568.40002 712.10999 l S 28.99001 641.85999 m 568.29999 641.85999 l S 28.99001 503.60999 m 568.29999 503.60999 l S 30.07001 814.72998 m 30.07001 711.03998 l S 92.12 745.73999 m 92.12 711.03998 l S 198.51999 745.73999 m 198.51999 711.03998 l S 290.62 745.73999 m 290.62 711.03998 l S 475.01999 745.73999 m 475.01999 711.03998 l S 567.32001 814.72998 m 567.32001 711.03998 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 800.46997 Tm (Statutory requirements)Tj 0 Tr 1 0 0 1 34.05 780.46997 Tm (These requirements set out what the registered person must do to meet th\ e Care )Tj 1 0 0 1 34.05 765.88995 Tm (Standards Act 2000, Care Homes)Tj 1 0 0 1 239.76999 765.88995 Tm (Regulations 2001 and the National Minimum )Tj 1 0 0 1 34.05 751.31 Tm (Standards. 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28.35001 739.60004 Tm (Email:)Tj 0 Tr 1 0 0 1 66.84 739.60004 Tm ( enquiries@cqc.org.uk)Tj 2 Tr 1 0 0 1 28.35001 719.60999 Tm (Web:)Tj 0 Tr 1 0 0 1 64.35001 719.60999 Tm (www.cqc.org.uk)Tj 1 0 0 1 28.35001 699.60999 Tm (\240)Tj 1 0 0 1 28.35001 679.60999 Tm (We want people to be able to access this information. If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1063 0 obj 38265 endobj 1064 0 obj<>stream HlVXTW{`=1v fubWtAQ`KD챏{q65X`rct;s;Pp+ϞN)K~1 8 MN}t@ [n`^NɠÀ/_6Y-VvpUmUrΐU'qMU~/bS ɯc|=68&2/GIy1v3Q;xj՘F1(eRN4hYxut\8|ygnU/,ԭ7UE7M%fp*WBEJTuVխFZԭN}dnM6kޢeyyom۵бS.]?ֽ߽}zw߾8h~8*аH11q c%OI01m)SM1s9̹8k/d+>]*go٦[mwwڽg:|ǎ8ygΞ;W"7oݾs/?fHT' &s p5t3x ) rɹrUk# m{SFzkQwս):}h0kMFƖQ&ar2U5U705z,p[<{\x\p8J9EwU,Hb1C'jԪhQZ{{RzW,*[`1%jEW,/Yp,s؀*E*)Ewn*)(X\X`FB}ABèւK+oP*Kt@TҜǺ}Ua*!&9kUud4,7yJl:(NB<ƿ>lRu<lYbB,nW2hSZ5\͸[ٜ۸]iΝý<P*[GaqJqXq\JsK~*\~%#jK.WyݦbS7Tip o*E)nW?lXTũs|JmY%vJ$TuC]4F*-NV}aWa]6@J zP~TڎUyP\5U!J2KPڞ4 |,zSQUGZ<\uprCEKJnU ,[8 UsZ[x"ֈ!ۭ!6hZr%&vm6[mU,^-Uh h\WnE$[kۼK&ث7 w˴hT?3羖 uɖ%nvM%KAIjQO"V >fc}l[GzYw1vcv S2}],Vu7q\N:N߶d²l,Lc qackjjH LҖФ1 Цa:0L̤3U ;2LOzｽ{{oۛ+3X\,",]ˢ]=p}7+Maꙩ(䲞Y p{3XlZSi aSX}4J%yDtc6:c=K:pܓVS,~q#N&Wn^)5Ap׃]fJ.BC ̧>B0V0$ *OWqg,~2s? 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(Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1071 0 obj 5469 endobj 1072 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1073 0 obj 9099 endobj 1074 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (46)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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m 567.84998 785.63 l S 28.99001 762.79999 m 567.84998 762.79999 l S 28.99001 687.22998 m 567.84998 687.22998 l S 28.99001 664.40002 m 567.84998 664.40002 l S 28.99001 641.57001 m 567.84998 641.57001 l S 28.99001 618.73999 m 567.84998 618.73999 l S 28.99001 595.90997 m 567.84998 595.90997 l S 30.07001 786.70996 m 30.07001 594.83997 l S 269.07001 786.70996 m 269.07001 594.83997 l S 566.76996 786.70996 m 566.76996 594.83997 l S BT /T1_0 12 Tf 1 0 0 1 34.05 769.45001 Tm (Name of care home:)Tj 1 0 0 1 273.04999 769.45001 Tm (Honiton Manor)Tj 1 0 0 1 34.05 746.62 Tm (Address:)Tj 1 0 0 1 273.04999 746.62 Tm (Exeter Rd )Tj 1 0 0 1 273.04999 729.03998 Tm (Honiton)Tj 1 0 0 1 273.04999 711.45996 Tm (Devon)Tj 1 0 0 1 273.04999 693.88 Tm (EX14 1AL)Tj 1 0 0 1 34.05 671.04999 Tm (Telephone number:)Tj 1 0 0 1 273.04999 671.04999 Tm (0140445204)Tj 1 0 0 1 34.05 648.21997 Tm (Fax number:)Tj 1 0 0 1 273.04999 648.21997 Tm (0140445324)Tj 1 0 0 1 34.05 625.39001 Tm (Email address:)Tj 1 0 0 1 273.04999 625.39001 Tm (honitonmanor@aol.com)Tj 1 0 0 1 34.05 602.56 Tm (Provider web address:)Tj 1 0 0 1 273.04999 602.56 Tm (oakdash@aol.com)Tj /T1_0 10 Tf 1 0 0 1 28.35001 583.60999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 109.98 w 32.32001 518.29999 m 564.76996 518.29999 l S 1 1 1 RG 64.32001 w 355.5 542.25 m 565.90002 542.25 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 497.54999 m 353.25 497.54999 l S 1 1 1 RG 355.5 497.54999 m 565.90002 497.54999 l S 0.95294 0.95294 0.95294 RG 31.2 474.72 m 353.25 474.72 l S 1 1 1 RG 355.5 474.72 m 565.90002 474.72 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13989 m 568.10004 486.13989 l S 28.99001 575.53998 m 568.10004 575.53998 l S 28.99001 508.97 m 568.10004 508.97 l S 28.99001 486.13989 m 568.10004 486.13989 l S 28.99001 463.31 m 568.10004 463.31 l S 30.07001 576.60999 m 30.07001 462.22998 l S 354.37 576.60999 m 354.37 462.22998 l S 567.01996 576.60999 m 567.01996 462.22998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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17 w 31.2 258 m 565.90002 258 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 248.37 m 568.10004 248.37 l S 30.07001 249.45 m 30.07001 39.14999 l S 567.01996 249.45 m 567.01996 39.14999 l S 28.99001 267.62 m 568.10004 267.62 l S 28.99001 248.37 m 568.10004 248.37 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 268.70001 m 30.07001 247.28998 l S 567.01996 268.70001 m 567.01996 247.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 254.43999 Tm (Brief description of the )Tj 1 0 0 1 177.31 254.43999 Tm (care home)Tj 1 0 0 1 35.5 235.18999 Tm (Honiton Manor is registered to provide 24 hour nursing care for up to 22\ service users )Tj 1 0 0 1 35.5 218.19 Tm (who have needs relating to 'older people'.)Tj 1 0 0 1 35.5 201.19 Tm (\240)Tj 1 0 0 1 35.5 184.19 Tm (The two-storey home is an older style building situated on the main road\ into, and )Tj 1 0 0 1 35.5 167.19 Tm (quite close to, Honiton and the local amenities. It is on public transpo\ rt routes.)Tj 1 0 0 1 35.5 150.19 Tm (\240)Tj 1 0 0 1 35.5 133.19 Tm (There are eleven single bedrooms and five double bedrooms situated on th\ e ground )Tj 1 0 0 1 35.5 116.19 Tm (and first floors. One of the double bedrooms has an ensuite bathroom. A \ passenger lift )Tj 1 0 0 1 35.5 99.19 Tm (and a staircase link the floors.)Tj 1 0 0 1 35.5 82.19 Tm (\240)Tj 1 0 0 1 35.5 65.19 Tm (Communal space is made up of a large lounge and a dining room, both on t\ he ground )Tj 1 0 0 1 35.5 48.19 Tm (floor.)Tj ET endstream endobj 1075 0 obj<>stream iText 1.3.6 (by lowagie.com) distributed with the Software Developer's Journal endstream endobj xref 6 1 0000497584 00000 n 11 1 0000497780 00000 n 14 1 0000497938 00000 n 16 1 0000498111 00000 n 18 1 0000498270 00000 n 22 1 0000498405 00000 n 24 1 0000498574 00000 n 26 1 0000498709 00000 n 28 1 0000498844 00000 n 30 1 0000498979 00000 n 35 1 0000499125 00000 n 37 1 0000499296 00000 n 39 1 0000499444 00000 n 41 1 0000499615 00000 n 43 1 0000499763 00000 n 45 1 0000499912 00000 n 47 1 0000500061 00000 n 49 1 0000500210 00000 n 51 1 0000500359 00000 n 53 1 0000500508 00000 n 56 1 0000500680 00000 n 58 1 0000500829 00000 n 60 1 0000500978 00000 n 62 1 0000501127 00000 n 64 1 0000501299 00000 n 66 1 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