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(9)Tj ET /F2 12 Tf BT 1 0 0 1 392.28 176.29 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 423.61 176.29 Tm (6)Tj ET /F2 12 Tf BT 1 0 0 1 454.95 176.29 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 486.28 176.29 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 517.6 176.29 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 548.96 176.29 Tm (0)Tj ET endstream endobj 6 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/XObject<>>>/MediaBox[0 0 612 792]>> endobj 7 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (2)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)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 28.35 768.28 Tm (Information about the care home)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 20.58 w 31.2 746.8 m 274.61 746.8 l S 0.001 w 1 1 1 RG 20.58 w 276.86 746.8 m 580.25 746.8 l S 0.001 w 0.95294 0.95294 0.95294 RG 90.9 w 31.2 688.81 m 274.61 688.81 l S 0.001 w 1 1 1 RG 90.9 w 276.86 688.81 m 580.25 688.81 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 31.2 630.82 m 274.61 630.82 l S 0.001 w 1 1 1 RG 20.58 w 276.86 630.82 m 580.25 630.82 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 31.2 607.99 m 274.61 607.99 l S 0.001 w 1 1 1 RG 20.58 w 276.86 607.99 m 580.25 607.99 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 31.2 585.16 m 274.61 585.16 l S 0.001 w 1 1 1 RG 20.58 w 276.86 585.16 m 580.25 585.16 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 31.2 562.33 m 274.61 562.33 l S 0.001 w 1 1 1 RG 20.58 w 276.86 562.33 m 580.25 562.33 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 735.39 m 582.46 735.39 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 642.23 m 582.46 642.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 619.41 m 582.46 619.41 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 596.58 m 582.46 596.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 573.74 m 582.46 573.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 758.22 m 582.46 758.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 735.39 m 582.46 735.39 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 642.23 m 582.46 642.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 619.41 m 582.46 619.41 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 596.58 m 582.46 596.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 573.74 m 582.46 573.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 550.91 m 582.46 550.91 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 759.29 m 30.07 549.84 l S 0.001 w [] 0 d [] 0 d 2.25 w 275.73 759.29 m 275.73 549.84 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 759.29 m 581.38 549.84 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 742.03 Tm (Name of care home:)Tj ET /F2 12 Tf BT 1 0 0 1 279.71 742.03 Tm (Two Gates House)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 719.2 Tm (Address:)Tj ET /F2 12 Tf BT 1 0 0 1 279.71 719.2 Tm (42-44 Two Gates House )Tj ET /F2 12 Tf BT 1 0 0 1 279.71 701.62 Tm (Two Gates Lane)Tj ET /F2 12 Tf BT 1 0 0 1 279.71 684.04 Tm (Colley Gate)Tj ET /F2 12 Tf BT 1 0 0 1 279.71 666.46 Tm (Halesowen)Tj ET /F2 12 Tf BT 1 0 0 1 279.71 648.88 Tm (B63 2LJ)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 626.05 Tm (Telephone number:)Tj ET /F2 12 Tf BT 1 0 0 1 279.71 626.05 Tm (01384567448)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 603.22 Tm (Fax number:)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 580.39 Tm (Email address:)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 557.56 Tm (Provider web address:)Tj ET /F2 10 Tf BT 1 0 0 1 28.35 521.61 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 502.13 m 353.25 502.13 l S 0.001 w 1 1 1 RG 20.58 w 355.5 502.13 m 565.9 502.13 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 31.2 433.64 m 353.25 433.64 l S 0.001 w 1 1 1 RG 20.58 w 355.5 433.64 m 565.9 433.64 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 31.2 410.8 m 353.25 410.8 l S 0.001 w 1 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provider\(s\):)Tj ET /F2 12 Tf BT 1 0 0 1 358.35 497.36 Tm (Wellmun Care Limited)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 474.52 Tm (Name of registered manager \(if applicable\))Tj ET /F2 12 Tf BT 1 0 0 1 34.05 451.7 Tm (Mrs )Tj ET /F2 12 Tf BT 1 0 0 1 59.76 451.7 Tm (Reshma )Tj ET /F2 12 Tf BT 1 0 0 1 112.21 451.7 Tm (Wellington)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 428.86 Tm (Type of registration:)Tj ET /F2 12 Tf BT 1 0 0 1 358.35 428.86 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 406.04 Tm (Number of places registered:)Tj ET /F2 12 Tf BT 1 0 0 1 358.35 406.04 Tm (28)Tj ET /F2 10 Tf BT 1 0 0 1 28.35 387.09 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 66.24 w 32.32 343.64 m 564.47 343.64 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 356.18 m 567.8 356.18 l S 0.001 w [] 0 d [] 0 d 2.25 w 297.24 333.36 m 567.8 333.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 379.02 m 567.8 379.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 356.18 m 567.8 356.18 l S 0.001 w [] 0 d [] 0 d 2.25 w 297.24 333.36 m 567.8 333.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 310.52 m 567.8 310.52 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 380.09 m 30.07 309.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 298.32 357.26 m 298.32 309.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 432.52 334.43 m 432.52 309.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.72 380.09 m 566.72 309.45 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 362.83 Tm (Conditions of registration:)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 340 Tm (Category\(ies\) :)Tj ET /F2 12 Tf BT 1 0 0 1 302.3 340 Tm (Number of places \(if applicable\):)Tj ET /F2 12 Tf BT 1 0 0 1 302.3 317.17 Tm (Under 65)Tj ET /F2 12 Tf BT 1 0 0 1 436.5 317.17 Tm (Over 65)Tj ET 1 1 1 RG 20.58 w 31.2 295.73 m 297.25 295.73 l S 0.001 w 20.58 w 299.5 295.73 m 429.25 295.73 l S 0.001 w 20.58 w 431.5 295.73 m 565.9 295.73 l S 0.001 w 35.16 w 31.2 265.61 m 297.25 265.61 l S 0.001 w 35.16 w 299.5 265.61 m 429.25 265.61 l S 0.001 w 35.16 w 431.5 265.61 m 565.9 265.61 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 284.32 m 568.1 284.32 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 307.15 m 568.1 307.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 284.32 m 568.1 284.32 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 246.91 m 568.1 246.91 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 308.23 m 30.07 245.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 298.37 308.23 m 298.37 245.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 430.37 308.23 m 430.37 245.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 308.23 m 567.02 245.83 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 290.96 Tm (dementia)Tj ET /F2 12 Tf BT 1 0 0 1 302.35 290.96 Tm (28)Tj ET /F2 12 Tf BT 1 0 0 1 434.35 290.96 Tm (28)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 268.14 Tm (old age, not falling within any other )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 253.55 Tm (category)Tj ET /F2 12 Tf BT 1 0 0 1 302.35 268.14 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 434.35 268.14 Tm (28)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 32.32 213.99 m 564.47 213.99 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 226.54 m 567.8 226.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 203.71 m 567.8 203.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 227.61 m 30.07 202.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.72 227.61 m 566.72 202.63 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 210.35 Tm (Conditions of registration:)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 188.91 m 315.25 188.91 l S 0.001 w 1 1 1 RG 20.58 w 317.5 188.91 m 346.55 188.91 l S 0.001 w 20.58 w 348.8 188.91 m 377.9 188.91 l S 0.001 w 20.58 w 380.15 188.91 m 409.2 188.91 l S 0.001 w 20.58 w 411.45 188.91 m 440.55 188.91 l S 0.001 w 20.58 w 442.8 188.91 m 471.9 188.91 l S 0.001 w 20.58 w 474.15 188.91 m 503.2 188.91 l S 0.001 w 20.58 w 505.45 188.91 m 534.55 188.91 l S 0.001 w 20.58 w 536.8 188.91 m 565.9 188.91 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 200.33 m 568.1 200.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 177.5 m 568.1 177.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 201.41 m 30.07 176.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 316.37 201.41 m 316.37 176.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 347.67 201.41 m 347.67 176.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 379.02 201.41 m 379.02 176.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 410.32 201.41 m 410.32 176.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 441.67 201.41 m 441.67 176.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 473.02 201.41 m 473.02 176.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 504.32 201.41 m 504.32 176.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 535.67 201.41 m 535.67 176.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 201.41 m 567.02 176.42 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 184.15 Tm (Date of last inspection)Tj ET /F2 12 Tf BT 1 0 0 1 328.2 184.15 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 359.53 184.15 Tm (6)Tj ET /F2 12 Tf BT 1 0 0 1 390.86 184.15 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 422.18 184.15 Tm (6)Tj ET /F2 12 Tf BT 1 0 0 1 453.53 184.15 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 484.86 184.15 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 516.18 184.15 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 547.53 184.15 Tm (9)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 165.63 m 565.9 165.63 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 156 m 568.1 156 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 157.08 m 30.07 34.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 157.08 m 567.02 34.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 175.25 m 568.1 175.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 156 m 568.1 156 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 35.8 m 568.1 35.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 176.33 m 30.07 154.92 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 176.33 m 567.02 154.92 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 162.07 Tm (Brief description of the )Tj ET /F2 12 Tf BT 1 0 0 1 177.31 162.07 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 142.82 Tm (The home is a large, detached; two storey building that has recently been extended. It )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 125.82 Tm (is situated two miles from Halesowen town centre and is within walking distance of )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 108.82 Tm (local shops. There is off road parking to the front of the building with a large garden to )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 91.82 Tm (the rear that has recently been landscaped with patio and seating for use when the )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 74.82 Tm (weather permits. They provide care and accomodation for elderly people who require )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 57.81 Tm (support. The service does not provide nursing care. Accommodation comprises )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 40.81 Tm (twenty six single bedrooms and the majority of them have en-suite facilities. There are )Tj ET endstream endobj 8 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 9 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (3)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 17 w 31.2 776.72 m 565.9 776.72 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 767.1 m 568.1 767.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 768.18 m 30.07 576.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 768.18 m 567.02 576.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 786.35 m 568.1 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 767.1 m 568.1 767.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 577.85 m 568.1 577.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 766.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 787.43 m 567.02 766.02 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 773.16 Tm (Brief description of the )Tj ET /F2 12 Tf BT 1 0 0 1 177.31 773.16 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 33.25 756.16 Tm (two bathrooms on each floor; two have assissted baths and two have showers, so )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 739.16 Tm (people have a choice of bathing facility to meet their needs. There are two )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 722.16 Tm (lounge/dinging areas on the ground floor providing people with a choice of areas to sit. )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 705.16 Tm (A passenger lift enables people to access all areas of the home and the home has a )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 688.16 Tm (range of equipment to assist people with reduced mobility e.g. portable hoists, hand )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 671.16 Tm (rails, toilet )Tj ET /F2 12 Tf BT 1 0 0 1 101.69 671.16 Tm (seats.)Tj ET /F2 12 Tf BT 1 0 0 1 137.66 671.16 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 654.16 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.25 637.16 Tm (There is a leaflet, service user guide, statement of purpose and web site providing )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 620.16 Tm (inforamtion for people who are considering moving into the home. People are advised )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 603.16 Tm (to contact the home for up to date information about )Tj ET /F2 12 Tf BT 1 0 0 1 358.61 603.16 Tm (fees.)Tj ET /F2 12 Tf BT 1 0 0 1 387.76 603.16 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 586.16 Tm ()Tj ET endstream endobj 10 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 11 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (4)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)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 28.35 745.27 Tm (What we found:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 691.53 w 31.2 389.44 m 580.26 389.44 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 736.33 m 582.46 736.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 737.41 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 737.41 m 581.38 41.47 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 720.15 Tm (We, the Care quality Commission \(CQC\) undertook this random inspection visit to )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 705.57 Tm (monitor standards of care at the home, which had been rated as Adequate at the last key )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 690.98 Tm (inspection on 26 June 2009. This random inspection was unannounced, which meant the )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 676.41 Tm (home was not given notice of our visit. We spent a day at the home and looked at the )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 661.83 Tm (medication systems and health care records and how people's healthcare needs were )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 647.24 Tm (being managed. We also looked at how people were supported and given assistance to )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 632.66 Tm (promote their health and well being. We looked at the management systems, including )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 618.09 Tm (staffing arrangements, how complaints were managed and how people at the home were )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 603.51 Tm (safeguarded. We briefly looked around the premises, including communal areas and a )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 588.92 Tm (sample of bedrooms. We spoke to people who were able, and to staff and visitors. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 574.34 Tm (observed interactions with people without verbal communication.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 559.77 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 545.18 Tm (At the previous key inspection a large number requirements were issued to improve )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 530.6 Tm (medication systems. We looked at a sample of the medication held at the home. There )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 516.03 Tm (were some improvements and some areas of good practice, such as a revised medication )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 501.45 Tm (procedure, basic audits and photographs with the MAR \(Medication Administration )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 486.86 Tm (Records\) charts, which reduced the risk of medication being given to the wrong person.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 472.29 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 457.7 Tm (However there was a lack of compliance with the previous requirements in some areas. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 443.13 Tm (We noted that not all staff administering medication had received accredited medication )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 428.55 Tm (training and the staff signature sheets needed to be updated. The protocols for the )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 413.96 Tm (administration of 'as and when needed' \(PRN\) medicines were not sufficiently detailed. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 399.39 Tm (The protocols did not always correspond with the MAR charts. There were no care plans )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 384.8 Tm (giving details of what would trigger the administration and no evaluations of efficacy of )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 370.23 Tm (medication administered. This meant there was no assurance people received their )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 355.64 Tm (medication appropriately to promote their health and well being. We also noted that some )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 341.07 Tm (handwritten entries on MAR charts had not been signed and witnessed by two trained )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 326.48 Tm (staff, which increased the risk of errors.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 311.9 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 297.33 Tm (There were a number of printed instructions on MAR sheets, which were 'as directed'. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 282.74 Tm (These did not give sufficient guidance to staff working in the home and should be clarified )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 268.17 Tm (with the prescriber or pharmacy provider.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 253.59 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 239.01 Tm (The bottles of liquid medication were sticky, as were some of the shelves in the drugs )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 224.43 Tm (trolley. We discussed the need to maintain the drugs trolleys in a clean condition to )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 209.85 Tm (maintain good standards of hygiene and infection control. We also recommended that )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 195.26 Tm (internal and external medicines should be stored separately to avoid contamination. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 180.68 Tm (saw opened containers of eye drops, labeled 'discard 28 days after opening', without a )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 166.1 Tm (date of opening. This meant that medication could be administered after it had passed its )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 151.52 Tm (safe date to be used. We also saw opened containers of creams in the drugs trolleys, )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 136.95 Tm (which were past their 'use by date'. Additionally liquid antibiotics, which were labeled to )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 122.36 Tm (be refrigerated, were found stored in the drugs trolley at room temperature.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 107.79 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 93.21 Tm (We saw that two people had been prescribed powerful antibiotics, but the signatures and )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 78.63 Tm (codes for non-administration on the MAR charts did not demonstrate that the medicines )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 64.04 Tm (were administered in accordance with the doctor's instructions. For example medicines )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 49.47 Tm (prescribed to be given four times daily were sometimes only given once daily with codes )Tj ET endstream endobj 12 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 13 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (5)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.8 775.41 Tm (for asleep or refused recorded at other times. There was no evidence these instances had )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 760.84 Tm (been discussed with the manager or the person's doctor. One person also prescribed )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 746.26 Tm (Nystatin oral drops had only received 18 doses over 10 days, instead of 30 doses )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 731.67 Tm (prescribed over seven days but the MAR chart had been signed as 'course completed'. )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 717.09 Tm (This medication was usually prescribed to treat oral thrush, a painful condition in the )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 702.52 Tm (mouth. We spoke to the relative who told us that the person, cared for in bed, was )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 687.93 Tm (reluctant eat. The acting manager acknowledged that there were no short term care )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 673.35 Tm (plans in place for the people requiring medication for limited periods. We looked at a )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 658.78 Tm (sample of care records and noted that there was no oral care plan, where mouth care )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 644.2 Tm (was required or evaluations to monitor infections had resolved.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 629.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 615.03 Tm (We noted that the staff were not always recording carried forward balances of medication )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 600.46 Tm (stocks on the MAR sheets, which meant that the accurate auditing of medication )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 585.88 Tm (dispensed in original containers could not be easily carried out. An example was Warfarin, )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 571.29 Tm (where the MAR chart showed, 56 3mg tablets had been received and 24 signatures had )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 556.72 Tm (been entered to indicate a dose had been administered but when we checked the stock of )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 542.14 Tm (medication remaining there were 44.5 tablets in two containers. In addition the person )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 527.55 Tm (should have received 1.5 tablets twice each week but the majority of entries did not show )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 512.97 Tm (the variable dose. The provider was present and confirmed our findings. He investigated )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 498.39 Tm (the discrepancies with a senior carer who stated that there was a carried forward balance )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 483.82 Tm (of stock, which had not been recorded. There was no assurance that this person had )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 469.23 Tm (received their anticoagulant medication to prevent blood clots as prescribed. This meant )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 454.65 Tm (that there were no assurances that people were always receiving their medicines as )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 440.08 Tm (prescribed by their doctor.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 425.49 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 410.92 Tm (The registered manager acknowledged that competency assessments had not been )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 396.33 Tm (carried out to ensure staff training was adequate and staff were knowledgeable about the )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 381.76 Tm (medication they were administering.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 367.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 352.6 Tm (We looked at the storage and administration of controlled drugs, which was generally )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 338.02 Tm (satisfactory, with all records and balances of medication accurate. This meant that people )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 323.43 Tm (requiring these powerful medicines were receiving them as prescribed by their doctor. )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 308.86 Tm (However Fentanyl Patches prescribed for someone on 30 November 2009 but )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 294.27 Tm (discontinued on 4 December 2009 had not been appropriately disposed of and were still )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 279.7 Tm (stored in the controlled drugs cabinet.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 265.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 250.54 Tm (The temperature records for the rooms where medication was stored in drugs trolleys )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 235.96 Tm (were not up to date. Furthermore the provider acknowledged there were no temperature )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 221.38 Tm (records for the room where medication stocks and the controlled drugs were kept. There )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 206.79 Tm (was no external ventilation for the room, which felt very warm. This meant that the )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 192.21 Tm (providers were not demonstrating that medication was consistently stored according to )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 177.63 Tm (manufacturers' instructions, which could result in medication not being efficacious to )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 163.05 Tm (maintain people's health. Robust records must be maintained and an effective air cooling )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 148.48 Tm (or air conditioning system should be considered.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 133.9 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 119.32 Tm (We looked at a sample of care records for people living at the home. At the previous )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 104.74 Tm (inspection we had reported that each person had a care plan, which was a typewritten )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 90.15 Tm ('Plan of Action'. These could be improved with specific detail to make them more person )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 75.57 Tm (centred. They were updated by the registered manager retyping the entire 'plan of action' )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 60.99 Tm (each month, rather than recording regular monthly evaluations. This had been discussed )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 46.42 Tm (at the previous inspection in June 2009. We looked at the care records for a person )Tj ET endstream endobj 14 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 15 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (6)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.8 775.41 Tm (admitted to the home two days prior to the inspection. Although this was a planned )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 760.84 Tm (admission there were areas of the assessment record where information was incomplete )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 746.26 Tm (and there were no risk assessments or care plans in place. This meant that staff did not )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 731.67 Tm (have sufficient written information and guidance to meet the person's needs.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 717.09 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 702.52 Tm (At the previous inspection we reported that risk assessments had been completed in )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 687.93 Tm (respect of manual handling, tissue viability, \(skin care\) nutrition, falls and bed safety )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 673.35 Tm (rails. At that time we noted that risk assessments for use of bed rails were general risk )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 658.78 Tm (assessments and did not highlight the various aspects to be taken into consideration )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 644.2 Tm (when considering bed rails for the safety of people in bed. The provider had subsequently )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 629.61 Tm (been served with an Improvement Notice by the Environmental Health Officer relating to )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 615.03 Tm (the safe use of bed rails. The provider assured us that the Environmental Health Officer )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 600.46 Tm (was satisfied with compliance at a recent visit to the home.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 585.88 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 571.29 Tm (The provider had removed the majority of bedrails and there were only one set of )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 556.72 Tm (bedrails in use for a frail person cared for in bed. Although risk assessments relating to )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 542.14 Tm (bedrails had improved not all aspects of risks relating to each person were included. For )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 527.55 Tm (example, though extra height bedrails had been provided and bedrail bumpers were in )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 512.97 Tm (place, we were told by the relative of the person in bed that she was frequently found )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 498.39 Tm (with her legs over the bedrail. This was not recorded as part of the risk assessment. )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 483.82 Tm (Similarly there was insufficient evidence to show what other control measures, such as )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 469.23 Tm (lowered beds, 'crash mats', had been considered for other people at risk of falling where )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 454.65 Tm (bedrails were not used.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 440.08 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 425.49 Tm (We saw that people had access to health care professionals such as GP's, dentist, )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 410.92 Tm (ophthalmic and chiropody services. We saw that district nurses were involved in the care )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 396.33 Tm (of people with pressure ulcer wounds.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 381.76 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 367.17 Tm (However the home's daily records did not adequately show how staff were providing )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 352.6 Tm (appropriate care for people vulnerable to pressure ulcers or diabetes. We saw a risk )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 338.02 Tm (assessment scored 'at high risk' but did not identify the person had pressure ulcers. The )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 323.43 Tm (generic risk assessment recorded 'pressure relieving mattress and cushion at all times', )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 308.86 Tm (but did not specify what sort of pressure relieving mattress or cushion or how they should )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 294.27 Tm (be monitored and checked. The person's nutritional risk assessment was scored 'low risk', )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 279.7 Tm (although there was recorded weight loss. District nurses notes advised 'to go to bed for 2 )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 265.11 Tm (hours each afternoon, position changes during day every half hour, night staff to do two )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 250.54 Tm (hourly checks'. There was no record to show position changes. The registered manager )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 235.96 Tm (acknowledged that there were no 'change of position' charts or detailed food and fluid )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 221.38 Tm (charts for people with pressure ulcers, or at risk of developing skin damage or with poor )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 206.79 Tm (appetite or weight loss.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 192.21 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 177.63 Tm (We looked at a sample of pressure relieving equipment including overlay and replacement )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 163.05 Tm (mattresses provided for people at risk of pressure damage to their skin. Risk assessments )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 148.48 Tm (were not sufficiently robust to ensure that the mattresses were used appropriately. )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 133.9 Tm (Examples were pressure settings on pressure relieving mattresses were not recorded and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 119.32 Tm (were not generally understood. We saw a pressure setting for 110kg on an AlphaExcell )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 104.74 Tm (mattress but the person's body weight was around 44kg. This meant that the mattress )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 90.15 Tm (might cause discomfort and not be effective in preventing tissue damage. We heard )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 75.57 Tm (another person complaining about back pain and not sleeping because of their mattress, )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 60.99 Tm (which was very uncomfortable. We viewed the bed with the registered manager and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 46.42 Tm (noted that the mattress, which was an 'overlay' to be used with the existing mattress, )Tj ET endstream endobj 16 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 17 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (7)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.8 775.41 Tm (had been placed on the bed base constructed of wooden slats. We were told that the )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 760.84 Tm (person had complained that the bed was too high with the original mattress and the )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 746.26 Tm (overlay mattress. The management need to offer other alternatives to this person and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 731.67 Tm (discuss the pressure relieving arrangements with relevant health care professionals.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 717.09 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 702.52 Tm (We noted that generally for people with fluctuating weight advice was sought from the )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 687.93 Tm (doctor and community dietician. The registered manager told us the staff had not )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 673.35 Tm (received specialist nutrition or diabetic training and acknowledged that additional training )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 658.78 Tm (would be beneficial to enhance skills and knowledge, improving the care for people with )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 644.2 Tm (poor nutrition or diabetes. We heard people in the new wing make requests for water to )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 629.61 Tm (drink at least three times during the inspection visit. We asked the provider if cool drinks )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 615.03 Tm (were routinely offered or made available for people to help themselves. He acknowledged )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 600.46 Tm (water and other cool drinks were not routinely left available but stated they would be in )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 585.88 Tm (future.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 571.29 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 556.72 Tm (We discussed discrepancies in records with the registered manager, such as information )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 542.14 Tm (in risk assessments evaluated at low risk and weight records showing weight loss or )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 527.55 Tm (pressure damage, which indicated high risks. She acknowledged that recording should be )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 512.97 Tm (more diligent and consistent.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 498.39 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 483.82 Tm (We noted that when people could no longer be weighed there was no alternative method )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 469.23 Tm (used to monitor their weight. We recommended that an alternative method of weight )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 454.65 Tm (monitoring should be used, such as the Malnutrition Universal Screening Tool \(MUST\) and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 440.08 Tm (the Mid Upper Arm Circumference \(MUAC\) should be measured when people are unable )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 425.49 Tm (to be weighed.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 410.92 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 396.33 Tm (We saw that there were records of daily routine preferences such as rising and retiring on )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 381.76 Tm (individual care files and generally people we spoke to confirmed that they had choice in )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 367.17 Tm (their daily routines. However we were shown records of a weekly bath rota with )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 352.6 Tm (everyone's names on a communal sheet. This method of record keeping was not )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 338.02 Tm (compliant with the Data Protection Act and did not give sufficient information about care )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 323.43 Tm (provided for each person.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 308.86 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 294.27 Tm (There were individual daily note sheets, which provided space for hourly observations, )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 279.7 Tm (with sections for fluids and meals, bowels, GP, nurses, hospital visits and weight and BMI, )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 265.11 Tm (but on a sample of records looked at, entries were very basic with most sections circled )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 250.54 Tm ('No' and they were not signed by the person completing the entries. Three records for )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 235.96 Tm (people with poor appetite, weight loss or pressure ulcers had no meals or fluids recorded )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 221.38 Tm (for the whole of the previous day.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 206.79 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 192.21 Tm (The evidence to show each person had access to appropriate professionals was difficult to )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 177.63 Tm (find and evaluate because a 'communal record' of professional visits was used. This )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 163.05 Tm (method of recording personal and sensitive information did not demonstrate compliance )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 148.48 Tm (with The Data Protection Act and did not show appropriate action in relation to the good )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 133.9 Tm (practice recommendations made at the previous inspection in June 2010. We also noted a )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 119.32 Tm (letter dated 2009 from the GP on one person's care records relating to high blood )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 104.74 Tm (pressure and the need for blood tests for cholesterol and kidney function. There was no )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 90.15 Tm (indication as to whether the blood tests had been organised or whether there were any )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 75.57 Tm (results. The registered manager was unable to confirm whether the requests in the letter )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 60.99 Tm (had been actioned.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 46.42 Tm ()Tj ET endstream endobj 18 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 19 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (8)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.8 775.41 Tm (Although the registered manager told us that tissue viability training was planned for staff )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 760.84 Tm (to attend in July 2010, in response to the previous good practice recommendation that )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 746.26 Tm (staff should be given training in respect of tissue viability and health conditions to )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 731.67 Tm (enhance their knowledge and understanding of peoples needs, it was evident that further )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 717.09 Tm (training and development was needed.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 702.52 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 687.93 Tm (We saw that people looked well presented and were dressed appropriately according to )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 673.35 Tm (their preference. There was good interaction between staff and the people living at the )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 658.78 Tm (home, with conversation at a level and pace appropriate for each person.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 644.2 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 629.61 Tm (We saw recent reviews conducted by social workers. The majority of comments were )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 615.03 Tm (positive and included, "staff are pleasant and treat X with respect"; "more than happy )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 600.46 Tm (with care at Two Gates"; "always smartly dressed and well presented".)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 585.88 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 571.29 Tm (People living at the home were complimentary saying, "the food is very, always a choice, )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 556.72 Tm (staff are helpful".)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 542.14 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 527.55 Tm (We looked at the home's systems to deal with complaints. We saw that there was a )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 512.97 Tm (complaints procedure displayed in the home included in the Service User Guide and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 498.39 Tm (displayed in each bedroom. The registered manager told us that there had been two )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 483.82 Tm (complaints in the last 12 months, with issues such as, 'being kept waiting for attention'. )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 469.23 Tm (The complaints had been appropriately investigated and the registered manager had )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 454.65 Tm (written to the complainants. We recommended that the letters of outcome should offer )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 440.08 Tm (complainants a timescale to express satisfaction and contact details should they remain )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 425.49 Tm (dissatisfied.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 410.92 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 396.33 Tm (The registered manager told us there had been two safeguarding referrals in the past 12 )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 381.76 Tm (months, which had been resolved. We also discussed two further safeguarding alerts )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 367.17 Tm (made by healthcare professionals relating to people with pressure ulcers requiring )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 352.6 Tm (hospital admissions. The registered manager offered assurances that improvements were )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 338.02 Tm (being made in accordance with professional advice. We saw evidence that district nurses )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 323.43 Tm (were now involved in the care of each person with any pressure damage at the home. )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 308.86 Tm (However the manager and staff did not always have detailed and accurate information )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 294.27 Tm (about the pressure ulcer wounds and treatment plan. This is an area of communication, )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 279.7 Tm (which should be improved.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 265.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 250.54 Tm (The home had policies and procedures to inform staff about abuse and responsibilities for )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 235.96 Tm (reporting suspicions or incidents. All staff were receiving safeguarding training, mainly )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 221.38 Tm (from the Local Authority training provider, so that they understood the lead agency's )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 206.79 Tm (procedure 'Safeguard and Protect' to protect vulnerable adults.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 192.21 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 177.63 Tm (We looked briefly around the premises and noted maintenance was being carried out to )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 163.05 Tm (acceptable standards. There were improvements such as ongoing redecoration and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 148.48 Tm (provision of new furniture, as it became necessary. The providers told us about the )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 133.9 Tm (improvements made since the last inspection; these included, new carpets and some new )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 119.32 Tm (furniture, the exterior of the home and lounge had been redecorated, the rear garden )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 104.74 Tm (had been landscaped and looked attractive, with paved areas and seating, a new )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 90.15 Tm (Television and Nintendo WI and had been purchased, the menu had been revised )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 75.57 Tm (following feedback from people living at home, now offering two daily choices at )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 60.99 Tm (mealtimes. There was a new website providing comprehensive information for people )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 46.42 Tm (wishing to know about the home and the provider was planning to install wireless internet )Tj ET endstream endobj 20 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 21 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (9)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 529.07 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 547.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 741.55 w 31.2 414.45 m 580.26 414.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 42.55 m 582.46 42.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 41.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 41.47 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.8 775.41 Tm (connection, with a view to having a laptop for people in the home to use to keep in touch )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 760.84 Tm (with relatives particularly if they live a distance away.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 746.26 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 731.67 Tm (We saw that there were 27 people accommodated at the home, on two units, with a )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 717.09 Tm (range of diverse needs. We looked at copies of staff rotas and discussed the staffing )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 702.52 Tm (levels with the registered manager in relation to occupancy and dependency levels. She )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 687.93 Tm (was able to give us information about the people accommodated, to identify what their )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 673.35 Tm (diagnosed conditions were and confirm the numbers of care staff to meet their needs. )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 658.78 Tm (There were four care staff, including a designated person in charge of each shift from )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 644.2 Tm (7am to 9pm, with support from the manager, cook and cleaner during main part of the )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 629.61 Tm (day. At night there were two waking care staff, with one person designated to be )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 615.03 Tm (responsible for the shift from 9pm to 7am. We noted that though the manager's name )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 600.46 Tm (was on the staff rota there were no recorded hours for her shifts.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 585.88 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 571.29 Tm (The registered manager told us that there were 10 care staff with an NVQ 2 Award with )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 556.72 Tm (five more staff undertaking NVQ level 2 training and two senior carers undertaking NVQ )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 542.14 Tm (level 3 training.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 527.55 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 512.97 Tm (We looked at a sample of two personnel files of staff recently employed. The files were )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 498.39 Tm (well organised with a recruitment checklist. The recruitment process was robust and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 483.82 Tm (provided safeguards for people living at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 469.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 454.65 Tm (The Registered Manager, Reshma Wellington told us she qualified as a social worker in )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 440.08 Tm (2002 and had experience of care homes. She holds the National Vocational Qualification )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 425.49 Tm (Level 3 in Care and is currently undertaking the Leadership and Management Skills )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 410.92 Tm (Award; she informed us this should be completed by the end of 2010. Mr and Mrs )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 396.33 Tm (Wellington own the limited company Wellman Care Ltd trading as Two Gates Care Home )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 381.76 Tm (and the company has been registered as the provider since June 2006.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 367.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 352.6 Tm (Mr Wellington had started to undertake quality assurance checks and audits, particularly )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 338.02 Tm (the management and administration of medication. He acknowledged our findings and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 323.43 Tm (informed us that though his audits had identified some areas where improvements were )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 308.86 Tm (needed more effort was required to achieve compliance with regulations.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 294.27 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 279.7 Tm (The registered manager told us she had informal meetings with small groups of staff. )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 265.11 Tm (There were no formal staff meetings or minutes for effective communication. There were )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 250.54 Tm (no residents or relatives meetings. The registered manager told us that relatives were )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 235.96 Tm (invited to care plan review meetings, though no-one had attended to date.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 221.38 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 206.79 Tm (The fire safety records appeared satisfactory and we noted that there were fire drills and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 192.21 Tm (additional fire training was planned for July 2010.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 177.63 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 163.05 Tm (We looked at the accident records and noted that there were 37 recorded accidents )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 148.48 Tm (involving people living at the home since March 2010. We noted that there were people )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 133.9 Tm (who had repeated falls, though we were told two of these people were no longer at the )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 119.32 Tm (home. The registered manager acknowledged that there were no documented analysis )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 104.74 Tm (and evaluations. This process would highlight trends and identify risks and should be )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 90.15 Tm (used to revise and update individual risk assessments to control or minimise hazards. )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 75.57 Tm (She told us that she had monthly care planning meetings with seniors and accidents were )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 60.99 Tm (reviewed informally. However from our brief evaluation we noted that a high number of )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 46.42 Tm (accidents were reported during the very early morning hours and there was no evidence )Tj ET endstream endobj 22 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 23 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (10)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 221.7 w 31.2 674.38 m 580.26 674.38 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 562.4 m 582.46 562.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 561.32 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 561.32 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.8 775.41 Tm (that this had been recognised or investigated.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 760.84 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 746.26 Tm (As previously highlighted the records regarding pressure ulcer care were not sufficiently )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 731.67 Tm (detailed, such as information about the grade of the wounds and preventative measures. )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 717.09 Tm (As a result appropriate Regulation 37 notifications had not been made to us. Furthermore )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 702.52 Tm (Regulation 37 notifications were not submitted for medication errors or for people )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 687.93 Tm (requiring investigations or treatment at hospital via the Accident and Emergency )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 673.35 Tm (department, particularly in relation to accidents at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 658.78 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 644.2 Tm (At the previous inspection in June 2009 we recommended that self auditing and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 629.61 Tm (evaluation should be reviewed, so that areas of improvement could be identified with )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 615.03 Tm (appropriate action plans put in place to demonstrate a proactive approach and continuous )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 600.46 Tm (development. As highlighted throughout this report to there were insufficient assurances )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 585.88 Tm (of robust quality assurance systems to ensure that each person living at the home was )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 571.29 Tm (receiving care to meet their needs in a consistent and person centred manner.)Tj ET /F2 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 544.33 Tm (What the care home)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 1 175.95 544.33 Tm (does well:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 239.28 w 31.2 413.5 m 580.26 413.5 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 534.27 m 582.46 534.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 292.73 m 582.46 292.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 535.34 m 30.07 291.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 535.34 m 581.38 291.66 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 518.08 Tm (This random inspection was conducted with full co operation of the registered manager )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 503.5 Tm (and provider.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 488.92 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 474.34 Tm (Proactive improvements had been made to the environment, such as new carpets, )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 459.76 Tm (redecoration and attractively rear landscaped garden.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 445.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 430.6 Tm (The home was clean, free from offensive odours, appropriately decorated and well )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 416.02 Tm (maintained with good quality furnishings and furniture.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 401.44 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 386.86 Tm (People living at the home told us food was good and staff were caring and friendly.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 372.28 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 357.7 Tm (The staff were friendly and made efforts to talk to people living at the home in a )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 343.12 Tm (reassuring manner and at a level and pace that people understood.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 328.54 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 313.96 Tm (Recruitment and selection procedures were robust and safeguard the people living at the )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 299.38 Tm (home. )Tj ET /F2 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 272.42 Tm (What they could do better:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 219.8 w 31.2 152.45 m 580.26 152.45 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 263.48 m 582.46 263.48 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 41.42 m 582.46 41.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 264.55 m 30.07 40.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 264.55 m 581.38 40.35 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 247.29 Tm (There must be closer liaison with health and social care professionals during the )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 232.71 Tm (assessment process in order to obtain information, so they have details about people's )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 218.13 Tm (past medical history and assessed needs.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 203.55 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 188.97 Tm (Care plans and risk assessments must be comprehensive with details about the support )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 174.39 Tm (people require, so care is person centred and each person's needs are met in a consistent )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 159.81 Tm (manner.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 145.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 130.65 Tm (Daily records must be more detailed and accurately reflect care provided and identify )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 116.07 Tm (concerns and people's health, social and psychological welfare, to ensure effective )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 101.49 Tm (monitoring.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 86.91 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 72.33 Tm (The pressure settings on pressure relieving mattresses should be recorded in care plans )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 57.75 Tm (and diligently monitored so that they are effective and comfortable for people needing to )Tj ET endstream endobj 24 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 25 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (11)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 367.5 w 31.2 601.47 m 580.26 601.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 786.35 m 582.46 786.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 416.6 m 582.46 416.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 787.43 m 30.07 415.52 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 787.43 m 581.38 415.52 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.8 775.41 Tm (use them.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 760.84 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 746.26 Tm (Weight loss must be carefully monitored and fluctuations must be investigated.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 731.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 717.09 Tm (Records of health and social care professionals visits should be on a separate sheet and )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 702.52 Tm (include the reason for the visit and outcome, so that care can be monitored and followed )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 687.93 Tm (up effectively.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 673.35 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 658.78 Tm (The assessments of risks related to falls and use of bedrails must include all risks )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 644.2 Tm (associated with the person and consideration should be given to all measures to minimise )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 629.61 Tm (the risks.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 615.03 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 600.46 Tm (Staff appropriate training relating to the health conditions of people living at the home to )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 585.88 Tm (enhance their knowledge and understanding of peoples need's and ensure each person is )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 571.29 Tm (supported effectively.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 556.72 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 542.14 Tm (The medication system must be improved to ensure safe storage and administration so )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 527.55 Tm (that people receive their medication prescribed as prescribed by their doctor.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 512.97 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 498.39 Tm (Staff supervision and competency assessments should be undertaken regularly, so that )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 483.82 Tm (staff receive the appropriate support, development and direction to provide good quality )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 469.23 Tm (care for people living in the home.)Tj ET /F2 12 Tf BT 1 0 0 1 31.8 454.65 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 31.8 440.08 Tm (The quality assurance systems should be developed further with the development of )Tj ET /F2 12 Tf BT 1 0 0 1 31.8 425.49 Tm (audits, meetings etc, to improve the process of feedback and continuous development.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 400.54 Tm (If you want to know what action the person responsible for this care home)Tj ET /F2 12 Tf BT 1 0 0 1 483.55 400.54 Tm (is taking )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 384.54 Tm (following this report, you can contact them using the details set out on page 2.)Tj ET endstream endobj 27 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 29 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (12)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 36.25 w 29.47 752.7 m 564.97 752.7 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 26.14 753.83 m 568.3 753.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 773.08 m 568.3 773.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 753.83 m 568.3 753.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 734.58 m 568.3 734.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.22 774.15 m 27.22 733.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 423.22 754.9 m 423.22 733.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 468.22 754.9 m 468.22 733.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 495.22 754.9 m 495.22 733.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 540.22 754.9 m 540.22 733.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 774.15 m 567.22 733.5 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 33.75 759.89 Tm (Are there any outstanding requirements from the last inspection?)Tj ET /F2 12 Tf BT 1 0 0 1 429.75 740.64 Tm (Yes)Tj ET /F3 12 Tf BT 1 0 0 1 476.37 742.58 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 501.75 740.64 Tm (No)Tj ET /F3 12 Tf BT 1 0 0 1 546.75 742.58 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 584.13 w 32.32 385.89 m 564.97 385.89 l S 0.001 w 1 1 1 RG 111.06 w 31.2 519.57 m 91.05 519.57 l S 0.001 w 111.06 w 93.3 519.57 m 197.4 519.57 l S 0.001 w 111.06 w 199.65 519.57 m 289.45 519.57 l S 0.001 w 111.06 w 291.7 519.57 m 473.8 519.57 l S 0.001 w 111.06 w 476.05 519.57 m 566.1 519.57 l S 0.001 w 125.64 w 31.2 398.96 m 91.05 398.96 l S 0.001 w 125.64 w 93.3 398.96 m 197.4 398.96 l S 0.001 w 125.64 w 199.65 398.96 m 289.45 398.96 l S 0.001 w 125.64 w 291.7 398.96 m 473.8 398.96 l S 0.001 w 125.64 w 476.05 398.96 m 566.1 398.96 l S 0.001 w 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d [] 0 d 2.25 w 198.52 577.3 m 198.52 92.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 577.3 m 290.57 92.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 577.3 m 474.92 92.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 680.2 m 568.4 680.2 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 608.77 m 568.4 608.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 576.22 m 568.4 576.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 462.91 m 568.3 462.91 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 335.02 m 568.3 335.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 221.71 m 568.3 221.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 93.82 m 568.3 93.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 681.28 m 30.07 575.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 609.85 m 92.12 575.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 609.85 m 198.52 575.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 609.85 m 290.62 575.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 609.85 m 475.02 575.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 681.28 m 567.32 575.14 l S 0.001 w [] 0 d /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 662.99 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 34.05 644.58 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 34.05 629.99 Tm (been met.)Tj ET /F2 12 Tf BT 1 0 0 1 95.57 629.99 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 104.02 629.99 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 34.05 615.41 Tm (Act 2000, )Tj ET /F2 12 Tf BT 1 0 0 1 96.58 615.41 Tm ( Regulations 2001 and the National Minimum Standards.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 597.59 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 594.59 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 594.59 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 594.59 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 594.59 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 582.45 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 560.03 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 560.03 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 560.03 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 560.03 Tm (All creams and eye drops )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 545.46 Tm (must be dated on opening )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 530.88 Tm (and discarded within )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 516.29 Tm (appropriate timescales. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 498.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 484.14 Tm (To reduce the risk of cross )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 469.55 Tm (infection.)Tj ET /F2 12 Tf BT 1 0 0 1 478.9 560.03 Tm (27/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 446.73 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 446.73 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 446.73 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 446.73 Tm (Staff must record the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 432.14 Tm (amount of medication at the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 417.57 Tm (beginning of each month. So )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 402.98 Tm (that auditing of medication )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 388.4 Tm (can take place. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 370.83 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 356.24 Tm (To ensure robust medication )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 341.67 Tm (systems are in place)Tj ET /F2 12 Tf BT 1 0 0 1 478.9 446.73 Tm (27/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 318.83 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 318.83 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 318.83 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 318.83 Tm (Staff must ensure the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 304.26 Tm (accurate administration and )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 289.67 Tm (recording of all medication. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 272.1 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 257.52 Tm (So people receive the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 242.93 Tm (medication prescribed for )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 228.35 Tm (them. )Tj ET /F2 12 Tf BT 1 0 0 1 478.9 318.83 Tm (27/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 205.52 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 205.52 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 205.52 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 205.52 Tm (Two staff must countersign )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 190.95 Tm (all handwritten medication )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 176.37 Tm (details. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 158.79 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 144.21 Tm (To ensure a robust checking )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 129.63 Tm (system is in place and people )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 115.04 Tm (receive the correct )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 100.46 Tm (medication.)Tj ET /F2 12 Tf BT 1 0 0 1 478.9 205.52 Tm (27/07/2009)Tj ET endstream endobj 30 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 31 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (13)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 554.36 16.38 Tm (19)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 28.35 770.27 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 28.35 754.85 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 32.32 692.47 m 564.97 692.47 l S 0.001 w 1 1 1 RG 20.58 w 31.2 649.83 m 91.05 649.83 l S 0.001 w 20.58 w 93.3 649.83 m 197.4 649.83 l S 0.001 w 20.58 w 199.65 649.83 m 289.45 649.83 l S 0.001 w 20.58 w 291.7 649.83 m 473.8 649.83 l S 0.001 w 20.58 w 476.05 649.83 m 566.1 649.83 l S 0.001 w [] 0 d 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This is a previous unmet Good )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 282.71 Tm (Practice Recommendation.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 259.89 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 259.89 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 259.89 Tm (Daily records must clearly indicate follow up of concerns )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 245.3 Tm (and people's health, social and psychological welfare. This )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 230.73 Tm (is a previous unmet Good Practice Recommendation. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 207.9 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 207.9 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 207.9 Tm (Advice from the diabetic specialist nursing service should )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 193.32 Tm (be sought for any person with diabetes, living at the home, )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 178.74 Tm (with records of screening, support and advice offered and )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 164.15 Tm (that a record be maintained of staff training in relation to )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 149.57 Tm (diabetes.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 126.75 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 126.75 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 126.75 Tm (The correct pressure setting for pressure relieving )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 112.17 Tm (mattresses should be recorded in each person's care )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 97.58 Tm (records with regular documented checks.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 74.75 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 74.75 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 74.75 Tm (Moving and handling risk assessments should reviewed and )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 60.17 Tm (expanded to include instructions for the level of assistance )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 45.6 Tm (and named equipment required for all transfers.)Tj ET endstream endobj 38 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 39 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 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 1 491.55 16.38 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 522.07 16.38 Tm (17)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 536.06 16.38 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 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are taken from the best practice described in the National )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 738.01 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 34.05 723.42 Tm (improving their service.)Tj ET /F2 10 Tf BT 1 0 0 1 34.05 702.6 Tm (No)Tj ET /F2 10 Tf BT 1 0 0 1 96.15 702.6 Tm (Refer to Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.45 702.6 Tm (Good Practice Recommendations)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 676.59 Tm (6)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 676.59 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 676.59 Tm (To ensure that people with poor nutritional intake and / or )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 662.02 Tm (weight loss are monitored using a recognised screening tool )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 647.43 Tm (as frequently as required by their risk assessment and care )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 632.85 Tm (plan.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 610.03 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 610.03 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 610.03 Tm (Staff should be given training in respect of tissue viability )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 595.45 Tm (and health conditions to enhance their knowledge and )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 580.86 Tm (understanding of peoples needs and ensure they are met )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 566.28 Tm (effectively. This is a previous unmet Good Practice )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 551.71 Tm (Recommendation.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 528.88 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 528.88 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 528.88 Tm (An up to date medication reference guide such as the )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 514.29 Tm (British National Formulary \(BNF\) should be available to )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 499.71 Tm (staff.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 476.89 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 476.89 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 476.89 Tm (Internal and external medicine should be stored separately )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 462.3 Tm (to avoid contamination.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 439.48 Tm (10)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 439.48 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 439.48 Tm (The management should seek clarification with the )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 424.89 Tm (prescriber or pharmacist of 'as directed' dosages on the )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 410.32 Tm (MAR charts, as this does not give sufficient guidance staff )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 395.73 Tm (as to how to administer medication.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 372.9 Tm (11)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 372.9 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 372.9 Tm (The medication policy for refusal of medication should be )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 358.33 Tm (expanded to include a time limit, after which advice should )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 343.74 Tm (be sought from the person's doctor.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 320.92 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 320.92 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 320.92 Tm (Carried forward stocks of medication should be recorded on )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 306.33 Tm (each persons MAR sheet and random audits of medication )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 291.76 Tm (stocks should be carried out, with recorded remedial action )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 277.17 Tm (for any discrepancies.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 254.35 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 254.35 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 254.35 Tm (There should be an up to date specimen staff signature list )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 239.76 Tm (for the administration of medication and that staff should )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 225.18 Tm (sign and date the home's medication policy to demonstrate )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 210.6 Tm (their awareness and compliance.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 187.77 Tm (14)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 187.77 Tm (27)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 187.77 Tm (Staffing should be kept under review to ensure that at all )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 173.2 Tm (times suitably qualified, competent and experienced )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 158.62 Tm (persons are on duty in sufficient numbers to meet the )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 144.04 Tm (needs and promote the health and welfare of each person )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 129.46 Tm (using the service.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 106.63 Tm (15)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 106.63 Tm (31)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 106.63 Tm (The registered manager's hours should be recorded on the )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 92.04 Tm (staff rota to demonstrate there is adequate managerial )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 77.46 Tm (time to provide leadership, support and monitoring to make )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 62.88 Tm (sure each person's needs are met effectively and their )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 48.31 Tm (health and welfare is safeguarded.)Tj ET endstream endobj 40 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 612 792]>> endobj 41 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 19.36 w 28.35 20.75 m 583.65 20.75 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 16.38 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 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Tel: 0870 600 5522. 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If you would like a summary in a )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 259 Tm (different format or language please contact our helpline or go to our website.)Tj ET /F2 18 Tf BT 1 0 0 1 28.35 232.98 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 210.26 Tm ( Care Quality Commission 2010)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 190.26 Tm (This publication may be reproduced in whole or in part in any format or medium for )Tj ET /F2 12 Tf BT 1 0 0 1 539.47 190.26 Tm (non-)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 172.77 Tm (commercial)Tj ET /F2 12 Tf BT 1 0 0 1 97.55 172.77 Tm ( purposes, provided that it is reproduced accurately and not used in a )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 155.27 Tm (derogatory manner or in a misleading context. 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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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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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