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 hRRz5}U4kD4'U׵=?DCYuk}?Kt;GSԯX-,t 8溼{khi]c?jK3(#.i\_kxR}?|@4a[7EHӒݡT䕓zMKPs(ڷ> , 1VzH/A1}~e;?[__ϳ?:Zo[Mo Uk?o&4[TާV~$CjVZ|9_AYLf^,|ekML$vZ?b]G鿰XiW/Jt> V8m"E H(O ো8`|4.lGGq|Gg9rL.Y ӧ9UWb+թC ,-jUzjTG?xF}ޞ^԰40 3ԨRYKҧHB1ERRr|Tg1OT+_Y O߆gO>)otK7º?A>i{ |'E} SU/, )otĂ}-FA_)?N_Y SU/, ZѧO#?R?Yg1OT+_Y O߆F >γ:+bfWG1OT+$kF7 ?2I|gtWݟ?RbfWGH'?o~d50:τ读?]?RO4?3kE'au _vK7º?] K_4iѐgO>)otK7º?A>i{ |'E} SU/, )otĂ}-FA_)?N_Y SU/, ZѧO#?R?Yg1OT+_Y O߆F >γ:+bfWG1OT+$kF7 ?2I|gtWݟ?RbfWGH'?o~d50:τ读?]?RO4?3kE'au _vK7º?] K_4iѐgO>)otK7º?A>i{ |'E} SU/, )otĂ}-FA_)?N_Y SU/, ZѧO#?R?Yg1OT+_Y O߆F >γ:+bfWG1OT+$kF7 ?2I|gtWݟ?RbfWGH'?o~d50:τ读?]?RO4?3kE'au _vK7º?] K_4iѐgO>)otK7º?A>i{ |'E} SU/, )otĂ}-FA_)?N_Y SU/, ZѧO#?R?Yg1OT+_Y O߆F >γ:+bfWG1OT+$kF7 ?2I|gtWݟ?RbfWGH'?o~d50:τ读?]?RO4?3kE'au _vK7º?] K_4iѐgO>)otK7º?A>i{ |'E} SU/, )otĂ}-FA_)?N_Y SU/, ZѧO#?R?Y߳G/nEw  '?c/hjy~Ծg+3~žPϸk^3b/ٖX*؜'5j> (VJPx̸_m7 [?kf*:VRTg4(J<((((W#4Se i h?=g5N㴲p[CƠ*FWyUݹڻٽyV]EU(((((((((((((((((((((((((((((((((((((( endstream endobj 4 0 obj <>stream 0 J q 546.75 0 0 62.25 28.35 0 cm /img0 Do Q q 553.5 0 0 108 28.35 678.35 cm /img1 Do Q /F1 14 Tf 0.75294 0.75294 0.75294 rg BT 0.75294 0.75294 0.75294 RG 0.5 w 2 Tr 1 0 0 1 129.91 657.28 Tm (Inspecting for better lives)Tj ET 0.001 w 0 Tr /F1 36 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 72.25 618.16 Tm (Random )Tj ET 0.001 w 0 Tr /F1 36 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 233.68 618.16 Tm (inspection report)Tj ET 0.001 w 0 Tr 0.98431 0.78824 0.08627 RG 17 w 22.95 572.94 m 580.6 572.94 l S 0.001 w /F1 24 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 537.82 Tm (Care homes for adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 20.58 w 31.2 511.91 m 164.46 511.91 l S 0.001 w 1 1 1 RG 20.58 w 166.71 511.91 m 580.25 511.91 l S 0.001 w 0.99608 0.9451 0.76078 RG 90.9 w 31.2 453.92 m 164.46 453.92 l S 0.001 w 1 1 1 RG 90.9 w 166.71 453.92 m 580.25 453.92 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 500.49 m 582.46 500.49 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 523.32 m 582.46 523.32 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 500.49 m 582.46 500.49 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 407.34 m 582.46 407.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 524.4 m 30.07 406.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 165.58 524.4 m 165.58 406.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 524.4 m 581.38 406.27 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 507.14 Tm (Name:)Tj ET /F1 12 Tf BT 1 0 0 1 169.56 507.14 Tm (Beech Spinney)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 484.31 Tm (Address:)Tj ET /F1 12 Tf BT 1 0 0 1 169.56 484.31 Tm (Beech Spinney )Tj ET /F1 12 Tf BT 1 0 0 1 169.56 466.73 Tm (Ironbridge)Tj ET /F1 12 Tf BT 1 0 0 1 169.56 449.15 Tm (Telford)Tj ET /F1 12 Tf BT 1 0 0 1 169.56 431.57 Tm (Shropshire)Tj ET /F1 12 Tf BT 1 0 0 1 169.56 413.99 Tm (TF8 7NE)Tj ET /F1 8 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 397.05 Tm ()Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 20.58 w 31.2 375.55 m 391.05 375.55 l S 0.001 w 1 1 1 RG 20.58 w 393.3 375.55 m 580.25 375.55 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 352.72 m 391.05 352.72 l S 0.001 w 1 1 1 RG 20.58 w 393.3 352.72 m 580.25 352.72 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 364.14 m 582.46 364.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 386.97 m 582.46 386.97 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 364.14 m 582.46 364.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 341.31 m 582.46 341.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 388.05 m 30.07 340.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 392.17 388.05 m 392.17 340.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 581.38 388.05 m 581.38 340.23 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 370.78 Tm (The quality rating for this care home is:)Tj ET /F1 12 Tf BT 1 0 0 1 396.14 370.78 Tm (one star adequate service)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 347.95 Tm (The rating was made on:)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 310 Tm (A quality rating is our assessment of how well a care home, agency or scheme is meeting )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 293 Tm (the needs of the people who use it. We give a quality rating following a full assessment of )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 276 Tm (the service. We call this a key inspection.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 242 Tm (This is a report of a )Tj ET /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 150.58 242 Tm (random)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 200.47 242 Tm (inspection)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 261.38 242 Tm ( of this care home. A )Tj ET /F1 12 Tf BT 1 0 0 1 392.12 242 Tm (random inspection is a short, )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 225 Tm (focussed inspection. Details of how to get other inspection reports for this care home, )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 208 Tm (including the last key inspection report, can be found on the last page of this report.)Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 173.52 m 315.25 173.52 l S 0.001 w 20.58 w 317.5 173.52 m 565.9 173.52 l S 0.001 w 1 1 1 RG 20.58 w 317.5 150.69 m 346.55 150.69 l S 0.001 w 20.58 w 348.8 150.69 m 377.9 150.69 l S 0.001 w 20.58 w 380.15 150.69 m 409.2 150.69 l S 0.001 w 20.58 w 411.45 150.69 m 440.55 150.69 l S 0.001 w 20.58 w 442.8 150.69 m 471.9 150.69 l S 0.001 w 20.58 w 474.15 150.69 m 503.2 150.69 l S 0.001 w 20.58 w 505.45 150.69 m 534.55 150.69 l S 0.001 w 20.58 w 536.8 150.69 m 565.9 150.69 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 162.1 m 568.1 162.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 184.93 m 568.1 184.93 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 162.1 m 568.1 162.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 139.27 m 568.1 139.27 l S 0.001 w [] 0 d [] 0 d 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Tf BT 1 0 0 1 392.28 145.92 Tm (0)Tj ET /F1 12 Tf BT 1 0 0 1 423.61 145.92 Tm (3)Tj ET /F1 12 Tf BT 1 0 0 1 454.95 145.92 Tm (2)Tj ET /F1 12 Tf BT 1 0 0 1 486.28 145.92 Tm (0)Tj ET /F1 12 Tf BT 1 0 0 1 517.6 145.92 Tm (0)Tj ET /F1 12 Tf BT 1 0 0 1 548.96 145.92 Tm (9)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 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (2)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 795.58 Tm (Information about the care home)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 20.58 w 31.2 774.1 m 267.21 774.1 l S 0.001 w 1 1 1 RG 20.58 w 269.46 774.1 m 563.65 774.1 l S 0.001 w 0.99608 0.9451 0.76078 RG 90.9 w 31.2 716.11 m 267.21 716.11 l S 0.001 w 1 1 1 RG 90.9 w 269.46 716.11 m 563.65 716.11 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 658.12 m 267.21 658.12 l S 0.001 w 1 1 1 RG 20.58 w 269.46 658.12 m 563.65 658.12 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 635.29 m 267.21 635.29 l S 0.001 w 1 1 1 RG 20.58 w 269.46 635.29 m 563.65 635.29 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 612.46 m 267.21 612.46 l S 0.001 w 1 1 1 RG 20.58 w 269.46 612.46 m 563.65 612.46 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 589.63 m 267.21 589.63 l S 0.001 w 1 1 1 RG 20.58 w 269.46 589.63 m 563.65 589.63 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 762.69 m 565.85 762.69 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 669.54 m 565.85 669.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 646.71 m 565.85 646.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 623.88 m 565.85 623.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 601.05 m 565.85 601.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 785.52 m 565.85 785.52 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 762.69 m 565.85 762.69 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 669.54 m 565.85 669.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 646.71 m 565.85 646.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 623.88 m 565.85 623.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 601.05 m 565.85 601.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 578.22 m 565.85 578.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 786.6 m 30.07 577.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 268.34 786.6 m 268.34 577.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 786.6 m 564.78 577.14 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 769.33 Tm (Name of care home:)Tj ET /F1 12 Tf BT 1 0 0 1 272.31 769.33 Tm (Beech Spinney)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 746.5 Tm (Address:)Tj ET /F1 12 Tf BT 1 0 0 1 272.31 746.5 Tm (Beech Spinney )Tj ET /F1 12 Tf BT 1 0 0 1 272.31 728.92 Tm (Ironbridge)Tj ET /F1 12 Tf BT 1 0 0 1 272.31 711.34 Tm (Telford)Tj ET /F1 12 Tf BT 1 0 0 1 272.31 693.76 Tm (Shropshire)Tj ET /F1 12 Tf BT 1 0 0 1 272.31 676.18 Tm (TF8 7NE)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 653.35 Tm (Telephone number:)Tj ET /F1 12 Tf BT 1 0 0 1 272.31 653.35 Tm (01952432065)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 630.52 Tm (Fax number:)Tj ET /F1 12 Tf BT 1 0 0 1 272.31 630.52 Tm (01952432209)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 607.69 Tm (Email address:)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 584.86 Tm (Provider web address:)Tj ET /F1 10 Tf BT 1 0 0 1 28.35 548.92 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 529.43 m 353.25 529.43 l S 0.001 w 1 1 1 RG 20.58 w 355.5 529.43 m 565.9 529.43 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 506.6 m 353.25 506.6 l S 0.001 w 1 1 1 RG 20.58 w 355.5 506.6 m 565.9 506.6 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 483.77 m 353.25 483.77 l S 0.001 w 1 1 1 RG 20.58 w 355.5 483.77 m 565.9 483.77 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 518.01 m 568.1 518.01 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 495.18 m 568.1 495.18 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 540.84 m 568.1 540.84 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 518.01 m 568.1 518.01 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 495.18 m 568.1 495.18 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 472.35 m 568.1 472.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 541.92 m 30.07 471.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 354.37 541.92 m 354.37 471.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 541.92 m 567.02 471.28 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 524.66 Tm (Name of registered provider\(s\):)Tj ET /F1 12 Tf BT 1 0 0 1 358.35 524.66 Tm (Self Unlimited)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 501.83 Tm (Type of registration:)Tj ET /F1 12 Tf BT 1 0 0 1 358.35 501.83 Tm (care home)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 479 Tm (Number of places registered:)Tj ET /F1 12 Tf BT 1 0 0 1 358.35 479 Tm (7)Tj ET /F1 10 Tf BT 1 0 0 1 28.35 460.05 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 440.56 m 565.6 440.56 l S 0.001 w 41.16 w 31.2 407.44 m 297.2 407.44 l S 0.001 w 20.58 w 299.45 417.73 m 565.6 417.73 l S 0.001 w 20.58 w 299.45 397.15 m 432.52 397.15 l S 0.001 w 20.58 w 432.52 397.15 m 565.6 397.15 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 429.15 m 567.8 429.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 451.98 m 567.8 451.98 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 429.15 m 567.8 429.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 385.74 m 567.8 385.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 453.06 m 30.07 384.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 298.32 430.23 m 298.32 384.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.72 453.06 m 566.72 384.66 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 435.79 Tm (Conditions of registration:)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 412.96 Tm (Category\(ies\) :)Tj ET /F1 12 Tf BT 1 0 0 1 302.3 412.96 Tm (Number of places \(if applicable\):)Tj ET /F1 12 Tf BT 1 0 0 1 302.3 392.38 Tm (Under 65)Tj ET /F1 12 Tf BT 1 0 0 1 435.37 392.38 Tm (Over 65)Tj ET 1 1 1 RG 20.58 w 31.2 370.95 m 297.25 370.95 l S 0.001 w 20.58 w 299.5 370.95 m 429.25 370.95 l S 0.001 w 20.58 w 431.5 370.95 m 565.9 370.95 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 382.36 m 568.1 382.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 359.53 m 568.1 359.53 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 383.44 m 30.07 358.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 298.37 383.44 m 298.37 358.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 430.37 383.44 m 430.37 358.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 383.44 m 567.02 358.46 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 366.18 Tm (learning disability)Tj ET /F1 12 Tf BT 1 0 0 1 302.35 366.18 Tm (7)Tj ET /F1 12 Tf BT 1 0 0 1 434.35 366.18 Tm (0)Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 327.74 m 565.6 327.74 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 316.33 m 567.8 316.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 249.76 m 568.1 249.76 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 339.16 m 567.8 339.16 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 316.33 m 568.1 316.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 249.76 m 568.1 249.76 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 226.93 m 568.1 226.93 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 340.24 m 30.07 225.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.72 340.24 m 566.72 225.85 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 322.97 Tm (Conditions of registration:)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 300.14 Tm (The registered person may provide the following category of service only: Care Home )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 285.56 Tm (Only \(Code PC\) To service users of the following gender: Either Whose primary care )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 270.98 Tm (needs on admission to the home are within the following categories: Learning disability )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 256.4 Tm (\(LD\) 7)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 233.57 Tm (The maximum number of service users who can be accommodated is: 7 )Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 212.14 m 315.25 212.14 l S 0.001 w 1 1 1 RG 20.58 w 317.5 212.14 m 346.55 212.14 l S 0.001 w 20.58 w 348.8 212.14 m 377.9 212.14 l S 0.001 w 20.58 w 380.15 212.14 m 409.2 212.14 l S 0.001 w 20.58 w 411.45 212.14 m 440.55 212.14 l S 0.001 w 20.58 w 442.8 212.14 m 471.9 212.14 l S 0.001 w 20.58 w 474.15 212.14 m 503.2 212.14 l S 0.001 w 20.58 w 505.45 212.14 m 534.55 212.14 l S 0.001 w 20.58 w 536.8 212.14 m 565.9 212.14 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 223.55 m 568.1 223.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 200.72 m 568.1 200.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 224.63 m 30.07 199.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 316.37 224.63 m 316.37 199.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 347.67 224.63 m 347.67 199.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 379.02 224.63 m 379.02 199.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 410.32 224.63 m 410.32 199.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 441.67 224.63 m 441.67 199.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 473.02 224.63 m 473.02 199.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 504.32 224.63 m 504.32 199.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 535.67 224.63 m 535.67 199.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 224.63 m 567.02 199.65 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 207.37 Tm (Date of last inspection)Tj ET 0.99608 0.9451 0.76078 RG 17 w 31.2 188.85 m 565.9 188.85 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 179.22 m 568.1 179.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 180.3 m 30.07 55.07 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 180.3 m 567.02 55.07 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 198.47 m 568.1 198.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 179.22 m 568.1 179.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 56.15 m 568.1 56.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 199.55 m 30.07 178.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 199.55 m 567.02 178.15 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 35.5 185.29 Tm (Brief description of the )Tj ET /F1 12 Tf BT 1 0 0 1 177.31 185.29 Tm (care home)Tj ET /F1 12 Tf BT 1 0 0 1 35.5 166.04 Tm (Beech Spinney is managed by Cottage and Rural Enterprises Ironbridge. The )Tj ET /F1 12 Tf BT 1 0 0 1 35.5 149.04 Tm (responsible individual is Mr Erik Whitehouse. The Registered Managers post is vacant )Tj ET /F1 12 Tf BT 1 0 0 1 35.5 132.04 Tm (and is being covered by an acting manager.)Tj ET /F1 12 Tf BT 1 0 0 1 35.5 115.04 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 35.5 98.04 Tm (Beech Spinney is registered with the Commission for Social Care Inspection as a )Tj ET /F1 12 Tf BT 1 0 0 1 35.5 81.04 Tm (residential Care Home for a maximum of seven adults with learning disabilities and )Tj ET /F1 12 Tf BT 1 0 0 1 35.5 64.04 Tm (additional complex needs. The registration consists of a five single bedroom permanent )Tj ET endstream endobj 8 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 9 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (3)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 17 w 31.2 804.03 m 565.9 804.03 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 794.4 m 568.1 794.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 795.48 m 30.07 638.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 795.48 m 567.02 638.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.1 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 794.4 m 568.1 794.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 639.15 m 568.1 639.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 793.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 814.73 m 567.02 793.33 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 35.5 800.47 Tm (Brief description of the )Tj ET /F1 12 Tf BT 1 0 0 1 177.31 800.47 Tm (care home)Tj ET /F1 12 Tf BT 1 0 0 1 33.25 783.47 Tm (home known as Honeysuckle House and an adjoining two-bedroom respite facility. The )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 766.47 Tm (respite home \(Thistle Lodge\) has a dedicated staff team and runs independently from )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 749.47 Tm (Honeysuckle House. All bedrooms have spacious en suite bathrooms and have access )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 732.47 Tm (\(via a tracking hoist if required\) to large assisted bathing and showering facilities. )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 715.47 Tm (Communal space at Honeysuckle House comprises of a large kitchen, dining room and )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 698.47 Tm (lounge. The gardens are landscaped and easily accessible. Beech Spinney also has use )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 681.47 Tm (of a resource centre that boasts an indoor pool and a fully equipped sensory room.)Tj ET /F1 12 Tf BT 1 0 0 1 33.25 664.47 Tm (We did not ask about fees at this random inspection and enquiries about fees should )Tj ET /F1 12 Tf BT 1 0 0 1 33.25 647.47 Tm (be directed to the service.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 627.09 Tm ()Tj ET endstream endobj 10 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 11 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (4)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 772.57 Tm (What we found:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 698.48 w 31.2 413.27 m 563.65 413.27 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 763.63 m 565.85 763.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 565.85 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 764.71 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 764.71 m 564.78 61.82 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 747.45 Tm (This inspection was a random inspection carried out on 5th March 2009 from 9.30am )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 732.87 Tm (to 7.30pm. The purpose of a random inspection is to focus on particular aspects of the )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 718.29 Tm (service, not all key National Minimum Standards as in a key inspection.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 703.71 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 689.13 Tm (At the last key inspection in July 2008 we recognised that the service was improving )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 674.55 Tm (and judged it as providing an adequate service overall. However the service still )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 659.97 Tm (needed to take steps to improve matters related to how it moved and handled people )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 645.39 Tm (to reduce risk and the number of injuries. It also needed to continue to improve how it )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 630.81 Tm (manages medication. To ensure such improvements, the last inspection report outlined )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 616.23 Tm (two requirements, one for moving and handling and the other for medication. The )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 601.65 Tm (purpose of this inspection was to assess to what extent these requirements for )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 587.07 Tm (improvement had been met. We therefore did not plan to assess most of the )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 572.49 Tm (recommendations made at the last inspection. They have not been carried forward into )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 557.91 Tm (this report, but progress towards them will be assessed at the next key inspection.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 543.33 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 528.75 Tm (Prior to inspection we planned what we were going to do by looking at information we )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 514.17 Tm (know about the service using previous inspection reports, the service's written )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 499.59 Tm (improvement plan and the Annual Quality Assurance Assessment or AQAA submitted )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 485.01 Tm (by the service to us prior to inspection in February 2009. The AQAA is a legal self )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 470.43 Tm (assessment document submitted by the service annually. It outlines what they think )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 455.85 Tm (they do well, what has improved and what they still need to improve as well as how )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 441.27 Tm (they are going to make these improvements.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 426.69 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 412.11 Tm (On the day of inspection we talked to the registered manager who although on leave )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 397.53 Tm (when we arrived, came in later. She was able to answer questions, supply )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 382.95 Tm (documentation and support the inspection process. Four of her senior staff were also )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 368.37 Tm (involved for varying periods of the inspection and supported the process in the same )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 353.79 Tm (way by answering questions and providing documentation. We met people who live at )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 339.21 Tm (Beech Spinney who are not able to answer questions as a consequence of their )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 324.63 Tm (disabilities. However we could see how they were being cared for by staff. We spoke to )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 310.05 Tm (two new support staff and also spoke to a further three staff members individually to )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 295.47 Tm (assess their knowledge of people's needs relating to moving and handling or )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 280.89 Tm (medication. In addition we looked at training records, care plans, medication records )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 266.31 Tm (and accident records. We followed up some recorded accidents by looking at the )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 251.73 Tm (environment and facilities where these accidents happened.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 237.15 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 222.57 Tm (We can see that the number of moving and handling incidents has decreased. Perusal )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 207.99 Tm (of accident records and talking to managers confirmed that there have not been any )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 193.41 Tm (moving and handling accidents to either the people living or working at Beech Spinney )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 178.83 Tm (since we last inspected in July 2008.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 164.25 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 149.67 Tm (Since the last inspection, there have been two admissions to Accident and Emergency. )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 135.09 Tm (One of these, where an injury was sustained was investigated under Safeguarding )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 120.51 Tm (procedures by multi agency partners as a possible moving and handling injury. The )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 105.93 Tm (conclusion was that there had not been a moving and handling accident or injury. We )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 91.35 Tm (talked to a staff member who could describe how the injured person requires moving )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 76.77 Tm (and handling and the staff member demonstrated a clear knowledge. The Manager )Tj ET endstream endobj 12 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 13 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (5)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 748.5 w 31.2 438.28 m 563.65 438.28 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 813.65 m 565.85 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 565.85 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 814.73 m 564.78 61.82 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 802.72 Tm (described the advice given by a physiotherapist and community nurse about this )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 788.14 Tm (person's moving and handling needs and the staff member repeated this accurately. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 773.56 Tm (The care plans had not been updated to reflect changes in condition but we could see )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 758.98 Tm (that information is being passed on to staff effectively.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 744.4 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 729.82 Tm (Moving and handling training took a disproportionate time to assess due to failures in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 715.24 Tm (recording systems.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 700.66 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 686.08 Tm (It is positive that since the last inspection a senior staff member has been trained to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 671.5 Tm (provide moving and handling training to staff. This avoids delays in the training )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 656.92 Tm (programme and a significant amount of practical training and update training has )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 642.34 Tm (taken place since the last inspection. Moving and handling theory training is being )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 627.76 Tm (provided separately often on different dates to the practical training but training )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 613.18 Tm (records do not distinguish between these courses, so it was difficult to assess who had )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 598.6 Tm (done what. In addition systems are not sufficiently developed to ensure that training )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 584.02 Tm (records are routinely updated following the provision of training. We asked if staff are )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 569.44 Tm (provided with certificates and received two different answers. The person who provides )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 554.86 Tm (the practical moving and handling training however, is not being asked to validate )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 540.28 Tm (certificates as we would expect. Often the only record there was of these practical )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 525.7 Tm (sessions was in the trainer's diary. Registers of attendance are held but we were told )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 511.12 Tm (these were not on the premises and were not available for inspection.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 496.54 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 481.96 Tm (During a protracted process, we were able to identify that all staff with the exception )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 467.38 Tm (of the Registered manager, a senior support worker and three bank staff have done )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 452.8 Tm (either training or retraining in moving and handling. We were able to verify a small )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 438.22 Tm (part of the newly provided practical training by asking an available staff member who )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 423.64 Tm (confirmed attendance on one of the dates.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 409.06 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 394.48 Tm (The registered manager has not done moving and handling training with this )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 379.9 Tm (organisation since taking up post. Given her position and the urgent need to improve )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 365.32 Tm (moving and handling practice since the last inspection, she recognised the implications )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 350.74 Tm (of this omission and undertook to ensure that she and those other people identified )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 336.16 Tm (would attend moving and handling training on a specified date in March 2009.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 321.58 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 307 Tm (The manager confirmed how since the last inspection the provision of moving and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 292.42 Tm (handling training to new staff has been prioritised before they are allowed to start )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 277.84 Tm (supporting people. We could see from talking to two new staff and from looking at )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 263.26 Tm (records, that for the most part this has been successful. Out of six new staff employed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 248.68 Tm (since the last inspection, five had received moving and handling training before )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 234.1 Tm (working their first shift. One bank staff member who regularly covers staff absences )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 219.52 Tm (has not been provided with appropriate training. We left the management team to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 204.94 Tm (consider what steps they were going to take to rectify this situation to assure the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 190.36 Tm (safety of people.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 175.78 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 161.2 Tm (We have previously been concerned about the number of falls incurred by some people )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 146.62 Tm (living at Beech Spinney, by two people in particular in Honeysuckle House. Although, )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 132.04 Tm (not directly always related to moving and handling, we looked into this as information )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 117.46 Tm (was available to us when we looked at the accident records.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 102.88 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 88.3 Tm (We could see that since the last inspection in July 2008 one person with a history of )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 73.72 Tm (falls had slid to the floor on 13 occasions and the other person had fallen on 5 )Tj ET endstream endobj 14 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 15 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (6)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 748.5 w 31.2 438.28 m 563.65 438.28 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 813.65 m 565.85 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 565.85 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 814.73 m 564.78 61.82 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 802.72 Tm (occasions. Each incident was without injury for both people although on one occasion )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 788.14 Tm (there was some slight grazing incurred. We looked further into three of the recorded )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 773.56 Tm (falls which were of particular concern. One person had fallen out of bed. We looked at )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 758.98 Tm (the bed and the bedroom and there were no evident hazards. We were assured by )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 744.4 Tm (senior staff that this was a one off event and that for now no further action is thought )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 729.82 Tm (to be necessary. The second person had trapped his foot between the mattress and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 715.24 Tm (bed frame during a seizure. We looked at the bed and found it to be an ordinary )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 700.66 Tm (double wooden framed bed without bedrails or fitments. The mattress fitted tightly into )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 686.08 Tm (the frame with no excessive gaps or evident hazards. It was difficult to see how a foot )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 671.5 Tm (could become trapped although it is more understandable considering this happened )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 656.92 Tm (during seizural activity. On reflection, perhaps one way of avoiding this risk in future )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 642.34 Tm (would be to have a divan style bed rather than a wooden framed bed but advice )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 627.76 Tm (should be sought about this.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 613.18 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 598.6 Tm (Positively since the last inspection, for the person at most risk of falls, the manager )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 584.02 Tm (has sought the advice of a falls prevention specialist who has carried out an )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 569.44 Tm (assessment and written a report. In addition a physiotherapist has carried out a )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 554.86 Tm (reassessment and updated written guidance for staff is available and is being acted on. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 540.28 Tm (Also a number of further actions have been taken to safeguard the person. These )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 525.7 Tm (include the provision of technical alert aids fitted to the person's mattress and bed. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 511.12 Tm (These alert the staff to movement and seizures so the person can have privacy and yet )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 496.54 Tm (be supervised when moving or experiencing seizures. In addition, the manager )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 481.96 Tm (explained how a new chair has been provided to prevent him falling sideways. A risk )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 467.38 Tm (assessment had been completed for the risk of falling sideways with the new chair as a )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 452.8 Tm (control measure. This included a safe system of using the chair but the risk )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 438.22 Tm (assessment had not been signed or dated.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 423.64 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 409.06 Tm (It was of concern then, given that this person is known to fall sideways, that the risk of )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 394.48 Tm (falling from the toilet had not been considered and that sufficient action had not been )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 379.9 Tm (taken when this person slid off the toilet to the left, suffering graising. The matter had )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 365.32 Tm (not been risk assessed before or after the accident and no action had been taken to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 350.74 Tm (prevent this happening again in the six months since the accident. When we looked at )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 336.16 Tm (the toilet we could see that there is a grab rail on the right but not on the left where )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 321.58 Tm (he fell. We were told that although he usually slides to the right, he would not be able )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 307 Tm (to use grab rails to support himself and to stop himself falling. We therefore concluded )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 292.42 Tm (that an urgent referral should be made for an occupational therapy assessment and in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 277.84 Tm (the meantime staff would be formally reminded of the need for sufficient preparation )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 263.26 Tm (and supervision at all times when providing his support.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 248.68 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 234.1 Tm (Assessing progress towards meeting the medication requirement was more )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 219.52 Tm (complicated.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 204.94 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 190.36 Tm (The requirement being assessed was that appropriate detailed information relating to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 175.78 Tm (medication must be kept, for example, in risk assessments, protocols and care plans to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 161.2 Tm (ensure that staff know how to use and monitor all medication including when required )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 146.62 Tm (and as directed medicines so that all medication is administered safely, correctly and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 132.04 Tm (as intended by the prescriber, to meet individual health needs.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 117.46 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 102.88 Tm (Information available to us was contradictory and there was confusion about the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 88.3 Tm (location and availability of medication protocols. The service's action plan for )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 73.72 Tm (improvement dated 1.9.08 tells us that since inspection all medication protocols were )Tj ET endstream endobj 16 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 17 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (7)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 748.5 w 31.2 438.28 m 563.65 438.28 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 813.65 m 565.85 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 565.85 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 814.73 m 564.78 61.82 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 802.72 Tm (revised by the required date with only 3 remaining with the relevant professional for )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 788.14 Tm (signature. At inspection, the registered manager told us that she fully believed all )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 773.56 Tm (protocols to have been returned, signed and authorised by the two doctors to whom )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 758.98 Tm (they had been sent. A senior support worker who has monthly liaison meetings with )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 744.4 Tm (the GP provided us with a list of protocols for each person that had not been received )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 729.82 Tm (back from the GP, twenty one in total. The service's action plan for improvement dated )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 715.24 Tm (1.9.08 also tells us that copies of the medical protocols are in people's daily record )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 700.66 Tm (files, care plans, emergency folders and medication files. We were advised by a senior )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 686.08 Tm (staff member that protocols are taken out of people's files and on this basis, we )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 671.5 Tm (agreed to initially look at protocols in the place where we were told they were most )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 656.92 Tm (likely to be, in the medication room.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 642.34 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 627.76 Tm (We looked at the availability of medication protocols for all five people living in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 613.18 Tm (Honeysuckle House and two people who have respite in Thistle Lodge.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 598.6 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 584.02 Tm (For the first person we looked at, all seven medication protocols were available in the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 569.44 Tm (medication room for medication taken both regularly and as required. Three of the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 554.86 Tm (seven had been signed and agreed by medical professionals and four had not. We later )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 540.28 Tm (also found copies of these written directions on the person's care file and on the office )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 525.7 Tm (computer. We spoke to a staff member who had a very good understanding of how to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 511.12 Tm (administer the medications we asked about, to this person.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 496.54 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 481.96 Tm (For the second person whose care we looked at, 3 medication protocols were available )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 467.38 Tm (on her file in the medication room. These had not been agreed as appropriate by )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 452.8 Tm (medics. Copies were held on the office computer, but were not available in her care )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 438.22 Tm (file. We talked to a different staff member about how and when to administer two of )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 423.64 Tm (these medications and again the staff member was able to demonstrate sufficient )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 409.06 Tm (knowledge which accorded with the unauthorised written guidance.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 394.48 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 379.9 Tm (We asked for medication protocols for a third person. We could see from her )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 365.32 Tm (medication administration records that she takes ten prescribed medications regularly )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 350.74 Tm (and two creams or ointments when required. There were no written protocols for this )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 336.16 Tm (person in the medication room. Two were later provided from the office computer, one )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 321.58 Tm (of which was dated November 2008 for a medication called cinnarazine that we did not )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 307 Tm (recognise as currently prescribed as it was not on the medication administration )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 292.42 Tm (record. Protocols to guide staff were also not available for the barrier cream and mouth )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 277.84 Tm (ulcer gel prescribed to be given as required, meaning these may be applied )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 263.26 Tm (inconsistently, on the wrong area of the body or not at all.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 248.68 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 234.1 Tm (We looked at what written medication guidance was available to staff for a fourth )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 219.52 Tm (person. We could see from his medication administration records that he is prescribed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 204.94 Tm (3 medications regularly and an additional three to be taken as required. There were no )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 190.36 Tm (medication protocols available for staff to consult in the medication room for this )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 175.78 Tm (person either for his regular or as required medications. This was confirmed by two )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 161.2 Tm (senior staff, one of whom explained that, anything we've not got here on site is with )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 146.62 Tm (the GP. We were later provided with one unsigned protocol for as required paracetomol )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 132.04 Tm (for this person which had been located on the computer. This was verbally confirmed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 117.46 Tm (to us as the only one available leading us to conclude that a number were missing and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 102.88 Tm (had not been developed to meet our requirement.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 88.3 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 73.72 Tm (We looked for medication protocols for the fifth person whose medication care we were )Tj ET endstream endobj 18 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 19 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (8)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 748.5 w 31.2 438.28 m 563.65 438.28 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 813.65 m 565.85 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 565.85 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 814.73 m 564.78 61.82 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 802.72 Tm (assessing. From his medication administration records, we could see that he is )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 788.14 Tm (prescribed five medications to be taken as required. He is also prescribed eye drops, )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 773.56 Tm (sodium cromaglicate which on the administration record are directed to be given four )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 758.98 Tm (times per day. Staff have changed the administration record to direct these to be given )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 744.4 Tm (as required. We could see from the administration records available starting from )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 729.82 Tm (23.2.09, that none had been administered. A senior staff member confirmed the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 715.24 Tm (change in direction to have been medically authorised. However no protocols were )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 700.66 Tm (available in the medication room where we were told we were most likely to find them. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 686.08 Tm (When we looked further, we were provided with what we were told was a finite version )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 671.5 Tm (of available protocols. Printed directly from the computer, we were given five written )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 656.92 Tm (medication protocols for this person. One of these describes regular oral medications )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 642.34 Tm (and the other four describe a variety of medications taken as required, including the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 627.76 Tm (eye drops referred to earlier. However protocols were not available for two other )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 613.18 Tm (additional as required medications listed as prescribed on his medication )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 598.6 Tm (administration record. These were for laratidine syrup and Niconzole. We asked a staff )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 584.02 Tm (member about how to administer this person's zolmitriptan nasal spray. The staff )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 569.44 Tm (member had not administered this before and was less sure of the prescribing )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 554.86 Tm (directions or how to use it. The staff member said it would be necessary to check the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 540.28 Tm (guidance. However we are not assured that this would be sufficiently and readily )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 525.7 Tm (accessible.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 511.12 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 496.54 Tm (Records show that medications prescribed as required are rarely being administered in )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 481.96 Tm (Honeysuckle House.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 467.38 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 452.8 Tm (We looked at administration practice by auditing some medication records for three )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 438.22 Tm (medications belonging to two people. We looked at how short courses of antibiotics )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 423.64 Tm (had been administered to two people. We did this because with antibiotics, there is a )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 409.06 Tm (clear start and end date. The number of staff signatures tallied with the number of )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 394.48 Tm (tablets prescribed. This combined with evidence that these medications had not been )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 379.9 Tm (returned to the pharmacy, shows us it is likely that the people received the full course )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 365.32 Tm (of treatments promoting their health and welfare. We then looked at how diazepam )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 350.74 Tm (prescribed on an ongoing basis to be taken as required had been administered to one )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 336.16 Tm (person over the course of the previous 12 months. Records over the 12 month period )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 321.58 Tm (showed 11 tablets to have been administered. As 28 had been prescribed we would )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 307 Tm (have expected 17 tablets to be left. A count showed that 17 were left. It would be )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 292.42 Tm (possible to conclude therefore that administration had been accountable and safe. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 277.84 Tm (However, as the service has still not implemented our recommendation to carry )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 263.26 Tm (forward remaining stock to the start of a new medication period, they are not able to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 248.68 Tm (sufficiently assure us that administration of medication is always accountable, safe and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 234.1 Tm (as the prescriber intended. To be assured, in this instance of good practice, records )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 219.52 Tm (would need to demonstrate that the 28 diazepam received into stock were )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 204.94 Tm (administered from a stock with a zero balance. Without a carry forward system, the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 190.36 Tm (service cannot adequately demonstrate this.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 175.78 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 161.2 Tm (We then shifted the focus of the inspection to look at how guidance for the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 146.62 Tm (administration of medication to individual people is provided for staff in Thistle Lodge )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 132.04 Tm (where people receive respite care. It is positive that prior to each persons stay, that )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 117.46 Tm (information about prescribed medication is sought from each person's GP.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 102.88 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 88.3 Tm (For the first person we looked at, it was clear from comparing his most recent care )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 73.72 Tm (plan to the fax received from the GP prior to admission that there had been medication )Tj ET endstream endobj 20 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 21 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (9)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 717.42 w 31.2 453.82 m 563.65 453.82 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 813.65 m 565.85 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 93.98 m 565.85 93.98 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 92.91 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 814.73 m 564.78 92.91 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.8 802.72 Tm (changes. Midazolam Buccal liquid and Timodine cream had been added to his )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 788.14 Tm (prescription. The faxed copy of the prescription tells staff that the midazolam is to be )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 773.56 Tm (given as 1ml after 5 minutes from the start of seizure, but no other information is )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 758.98 Tm (available to ensure its safe administration at a time of trauma. Also this same )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 744.4 Tm (document tells staff to apply Timodine cream twice daily without further information )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 729.82 Tm (about why, where on the body and how.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 715.24 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 700.66 Tm (There was the further potential for error in medications for the second person who )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 686.08 Tm (uses Thistle Lodge as a respite facility. The most recent care plan lists the names of 4 )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 671.5 Tm (medications without stating the dose, frequency or times that each medication should )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 656.92 Tm (be administered. Following the list it states, this is usually given during breakfast. It is )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 642.34 Tm (not clear whether this instruction refers to all meds or the latter on the list. Reference )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 627.76 Tm (to a copy of the prescription provided prior to admission by the GP shows one of the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 613.18 Tm (list of medications must be administered at night. Neither the care plan nor the faxed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 598.6 Tm (prescription from the GP provides guidance how to administer any of the medications )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 584.02 Tm (listed. The faxed prescription states Loratidine tablets 10mg 1 or 2 as required, )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 569.44 Tm (Omeprazole dispersible 10mg 1 to 2 tablets once daily and melatonin 9mg at night. A )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 554.86 Tm (definition of when required is not provided and staff are not guided to know how to )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 540.28 Tm (judge whether to administer one or two tablets in either the information provided from )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 525.7 Tm (the surgery or in the care plan. The maximum dose in a given period is not stated. )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 511.12 Tm (Therefore our conclusion is that there is inadequate information to ensure that staff )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 496.54 Tm (know how to administer each medication safely. This puts people at some risk and is )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 481.96 Tm (concerning given the length of time the service has had since we last inspected. Risk is )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 467.38 Tm (however minimised by the fact that no controlled drugs are now held or managed on )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 452.8 Tm (the premises, the number of medication errors has reduced with none reported in the )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 438.22 Tm (nine month period since the last inspection and an improvement in the provision of )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 423.64 Tm (medication training to staff.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 409.06 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 394.48 Tm (Four different medication training courses remain listed on the training matrix. Since )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 379.9 Tm (the last inspection in July 2008, we can see from the matrix that 8 staff still employed )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 365.32 Tm (have done MDS Boots training including 4 bank staff. We can also can see that 15 staff )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 350.74 Tm (including 4 bank staff have done handling medication training since last inspection July )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 336.16 Tm (2008. From the matrix it seems that all staff with the exception of one, have done at )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 321.58 Tm (least one form of medication training with 18 staff having done at least 2 meds )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 307 Tm (courses. The service in its AQAA, recognises the need to increase the numbers of staff )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 292.42 Tm (undertaking full medication training. We agree, as we can see that very few staff have )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 277.84 Tm (done externally assessed distance learning training with those that have having )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 263.26 Tm (completed this mostly back in 2006 and 2007, with only one person completing this )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 248.68 Tm (since then. We can see that steps have been taken to ensure staff previously involved )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 234.1 Tm (in medication errors have received some training although progress with this is unclear )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 219.52 Tm (for one of these people still. A new system of structured training and assessment is )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 204.94 Tm (being implemented for new staff. We confirmed this by talking to two new staff and )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 190.36 Tm (looking at medication records. This limits risks of medication errors by inexperienced )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 175.78 Tm (people. The provision of what the manager has described as full medication training )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 161.2 Tm (should now be prioritised.)Tj ET /F1 12 Tf BT 1 0 0 1 31.8 146.62 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 31.8 132.04 Tm (However, as a result of our concerns about compliance, we served a Code B notice )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 117.46 Tm (under The Police and Criminal Evidence Act to enable us to continue to investigate a )Tj ET /F1 12 Tf BT 1 0 0 1 31.8 102.88 Tm (possible breach and to seize documentation as evidence of possible none compliance.)Tj ET /F1 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 75.91 Tm (What the care home)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F1 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 175.95 75.91 Tm (does well:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr endstream endobj 22 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 23 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (10)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 151.8 w 31.2 736.63 m 563.65 736.63 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 813.65 m 565.85 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 659.6 m 565.85 659.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 658.53 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 814.73 m 564.78 658.53 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 797.47 Tm (There is no doubt that overall, compared to performance a year ago the service has )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 782.89 Tm (improved. Staff morale remains good, shifts are directed well, communication is )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 768.31 Tm (improved within the service and with external agencies and staff are calm, focussed, )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 753.73 Tm (are aware of their roles and people's needs as well as how to better meet people's )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 739.15 Tm (needs. Incidents and accidents have reduced and new staff are being inducted well )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 724.57 Tm (before they support people. This improves peoples safety. There have been no moving )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 709.99 Tm (and handling related incidents since we last inspected.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 695.41 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 680.83 Tm (The service is keen to improve and everyone involved worked openly and )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 666.25 Tm (cooperatively with us, throughout a long and tiring inspection day.)Tj ET /F1 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 638.16 Tm (What they could do better:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr 1 1 1 RG 487.14 w 31.2 383.4 m 563.65 383.4 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 628.09 m 565.85 628.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 138.7 m 565.85 138.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 629.17 m 30.07 137.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 629.17 m 564.78 137.63 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 611.91 Tm (The managers involved in the inspection day said that care practices have improved )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 597.33 Tm (and that many things have been done to support this. They acknowledged however )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 582.75 Tm (that documentation is not always up to date. This protracts the inspection process and )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 568.17 Tm (limits how they can monitor and develop their own service quality. Care plans and )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 553.59 Tm (training records are examples of this. Training must now be prioritised for the few )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 539.01 Tm (remaining staff who have not had moving and handling training or sufficient refresher )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 524.43 Tm (training. We will not delete this requirement until this has been satisfactorily met, but )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 509.85 Tm (on the basis of the level of improvement and reduction in moving and handling )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 495.27 Tm (accidents, we did not seize documentation under Code B of the Police and Criminal )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 480.69 Tm (Evidence Act 1984.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 466.11 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 451.53 Tm (Falls should continue to be monitored. The manager must ensure that staff bring all )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 436.95 Tm (accidents and near misses to her attention for review so action can be taken without )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 422.37 Tm (delay to minimise the risk of a reoccurrence. Advice must be sought about how to )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 407.79 Tm (minimise the risk of falls from the toilet for one person, with interim measures to )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 393.21 Tm (reduce risk implemented until this advice can be obtained and acted upon.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 378.63 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 364.05 Tm (Steps must be taken to ensure compliance with the outstanding requirement to ensure )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 349.47 Tm (sufficient written guidance is in place for staff about the administration of all )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 334.89 Tm (medications for all people. These protocols must be readily accessible to all staff and )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 320.31 Tm (should have been approved by the prescribing medic to confirm that the guidance )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 305.73 Tm (supports the safe administration of medications as intended.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 291.15 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 276.57 Tm (The service also needs to implement a carry forward system in its medication records )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 261.99 Tm (so it can clearly show through auditing, that medications are being administered as )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 247.41 Tm (prescribed from the beginning of the medication period. Medications are received from )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 232.83 Tm (the pharmacy on a Friday. These are checked in at this time. For accuracy and clarity, )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 218.25 Tm (it is advised that the carry forward system is calculated on Sunday evenings after the )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 203.67 Tm (last administration, ready to start on Monday mornings.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 189.09 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 34.05 174.51 Tm (On the basis of insufficient progress and the potential for risk to people from lack of )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 159.93 Tm (suitable medication guidance, we issued a Code B notice under the Police and Criminal )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 145.35 Tm (Evidence Act 1994 and took evidence in relation to possible non compliance.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 120.39 Tm (If you want to know what action the person responsible for this care home)Tj ET /F1 12 Tf BT 1 0 0 1 483.55 120.39 Tm (is taking )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 104.39 Tm (following this report, you can contact them using the details set out on page 2.)Tj ET endstream endobj 24 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 26 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (11)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99216 0.9451 0.76078 RG 36.25 w 29.47 780 m 564.97 780 l S 0.001 w 0.99608 0.9451 0.76078 RG 17 w 28.35 771.5 m 422.1 771.5 l S 0.001 w 17 w 424.35 771.5 m 467.1 771.5 l S 0.001 w 1 1 1 RG 17 w 469.35 771.5 m 494.1 771.5 l S 0.001 w 0.99608 0.9451 0.76078 RG 17 w 496.35 771.5 m 539.1 771.5 l S 0.001 w 1 1 1 RG 17 w 541.35 771.5 m 566.1 771.5 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 26.14 781.13 m 568.3 781.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 800.38 m 568.3 800.38 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 781.13 m 568.3 781.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 761.88 m 568.3 761.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.22 801.46 m 27.22 760.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 423.22 782.21 m 423.22 760.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 468.22 782.21 m 468.22 760.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 495.22 782.21 m 495.22 760.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 540.22 782.21 m 540.22 760.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 801.46 m 567.22 760.8 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 33.75 787.19 Tm (Are there any outstanding requirements from the last inspection?)Tj ET /F1 12 Tf BT 1 0 0 1 429.75 767.94 Tm (Yes)Tj ET /F2 12 Tf BT 1 0 0 1 476.37 769.89 Tm (5)Tj ET /F1 12 Tf BT 1 0 0 1 501.75 767.94 Tm (No)Tj ET /F2 12 Tf BT 1 0 0 1 546.75 769.89 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 81.9 w 31.2 699.43 m 566.2 699.43 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 741.5 m 568.4 741.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 742.58 m 30.07 658.48 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 742.58 m 567.32 658.48 l S 0.001 w [] 0 d /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 725.32 Tm (Outstanding statutory requirements)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 34.05 707.74 Tm (These requirements were set at the last inspection. They may not have been looked at )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 693.16 Tm (during this inspection, as a )Tj ET /F1 12 Tf BT 1 0 0 1 201.54 693.16 Tm (random inspection is short and focussed. The registered )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 678.58 Tm (person must take the necessary action to comply with these requirements within the )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 664 Tm (timescales set.)Tj ET 0.99608 0.9451 0.76078 RG 30.3 w 31.2 639.95 m 91 639.95 l S 0.001 w 30.3 w 93.25 639.95 m 197.4 639.95 l S 0.001 w 30.3 w 199.65 639.95 m 289.5 639.95 l S 0.001 w 30.3 w 291.75 639.95 m 473.9 639.95 l S 0.001 w 30.3 w 476.15 639.95 m 566.2 639.95 l S 0.001 w 1 1 1 RG 300.6 w 31.2 472.25 m 91.05 472.25 l S 0.001 w 300.6 w 93.3 472.25 m 197.4 472.25 l S 0.001 w 300.6 w 199.65 472.25 m 289.45 472.25 l S 0.001 w 300.6 w 291.7 472.25 m 473.8 472.25 l S 0.001 w 300.6 w 476.05 472.25 m 566.1 472.25 l S 0.001 w 242.28 w 31.2 198.56 m 91.05 198.56 l S 0.001 w 242.28 w 93.3 198.56 m 197.4 198.56 l S 0.001 w 242.28 w 199.65 198.56 m 289.45 198.56 l S 0.001 w 242.28 w 291.7 198.56 m 473.8 198.56 l S 0.001 w 242.28 w 476.05 198.56 m 566.1 198.56 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 623.68 m 568.4 623.68 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 657.31 m 92.12 319.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 657.31 m 290.62 319.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 657.31 m 475.02 319.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 320.83 m 568.3 320.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 656.23 m 568.4 656.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 623.68 m 568.3 623.68 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 320.83 m 568.3 320.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 76.3 m 568.3 76.3 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 657.31 m 30.07 75.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 624.76 m 92.17 75.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 657.31 m 198.52 75.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 624.76 m 290.57 75.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 624.76 m 474.92 75.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 657.31 m 567.32 75.22 l S 0.001 w [] 0 d /F1 10 Tf BT 1 0 0 1 34.05 642.05 Tm (No.)Tj ET /F1 10 Tf BT 1 0 0 1 96.1 642.05 Tm (Standard)Tj ET /F1 10 Tf BT 1 0 0 1 202.5 642.05 Tm (Regulation)Tj ET /F1 10 Tf BT 1 0 0 1 294.6 642.05 Tm (Requirement)Tj ET /F1 10 Tf BT 1 0 0 1 479 642.05 Tm (Timescale for )Tj ET /F1 10 Tf BT 1 0 0 1 479 629.9 Tm (action)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 607.49 Tm (1)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 607.49 Tm (20)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 607.49 Tm (13\(2\))Tj ET /F1 12 Tf BT 1 0 0 1 294.55 607.49 Tm (Appropriate detailed )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 592.91 Tm (information relating to )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 578.33 Tm (medication must be kept, for )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 563.75 Tm (example, in risk )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 549.17 Tm (assessments, protocols and )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 534.59 Tm (care plans to ensure that )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 520.01 Tm (staff know how to use and )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 505.43 Tm (monitor all medication )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 490.85 Tm (including when required and )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 476.27 Tm (as directed medicines so that )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 461.69 Tm (all medication is )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 447.11 Tm (administered safely, correctly )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 432.53 Tm (and as intended by the )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 417.95 Tm (prescriber, to meet individual )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 403.37 Tm (health needs.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 388.79 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 374.21 Tm (This requirement was not )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 359.63 Tm (met at this inspection July )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 345.05 Tm (2008.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 327.47 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 478.9 607.49 Tm (31/07/2008)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 304.64 Tm (2)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 304.64 Tm (42)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 304.64 Tm (13\(5\))Tj ET /F1 12 Tf BT 1 0 0 1 294.55 304.64 Tm (Suitable arrangements to )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 290.06 Tm (provide a safe system for )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 275.48 Tm (moving and handling service )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 260.9 Tm (users must be made. This )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 246.32 Tm (must include providing full )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 231.74 Tm (moving and handling training )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 217.16 Tm (to new staff prior to )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 202.58 Tm (undertaking the moving and )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 188 Tm (handling of service users and )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 173.42 Tm (refresher training to staff at )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 158.84 Tm (sufficient intervals.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 144.26 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 129.68 Tm (New requirement arising )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 115.1 Tm (from this inspection July )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 100.52 Tm (2008.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 82.94 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 478.9 304.64 Tm (31/07/2008)Tj ET endstream endobj 28 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 30 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (12)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 793.57 Tm (Requirements and recommendations from this inspection)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 52.74 w 31.2 733.59 m 566.2 733.59 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 761.09 m 568.4 761.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 762.17 m 30.07 707.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 762.17 m 567.32 707.22 l S 0.001 w [] 0 d /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 744.9 Tm (Immediate requirements:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 34.05 727.32 Tm (These are immediate requirements that were set on the day we visited this )Tj ET /F1 12 Tf BT 1 0 0 1 493.86 727.32 Tm (care home. )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 712.74 Tm (The registered person had to meet these within 48 hours.)Tj ET 0.99608 0.9451 0.76078 RG 30.3 w 31.2 688.7 m 91 688.7 l S 0.001 w 30.3 w 93.25 688.7 m 197.4 688.7 l S 0.001 w 30.3 w 199.65 688.7 m 289.5 688.7 l S 0.001 w 30.3 w 291.75 688.7 m 473.9 688.7 l S 0.001 w 30.3 w 476.15 688.7 m 566.2 688.7 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 704.97 m 568.4 704.97 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 672.42 m 568.4 672.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 706.05 m 30.07 671.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 706.05 m 92.12 671.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 706.05 m 198.52 671.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 706.05 m 290.62 671.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 706.05 m 475.02 671.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 706.05 m 567.32 671.35 l S 0.001 w [] 0 d /F1 10 Tf BT 1 0 0 1 34.05 690.8 Tm (No.)Tj ET /F1 10 Tf BT 1 0 0 1 96.1 690.8 Tm (Standard)Tj ET /F1 10 Tf BT 1 0 0 1 202.5 690.8 Tm (Regulation)Tj ET /F1 10 Tf BT 1 0 0 1 294.6 690.8 Tm (Requirement)Tj ET /F1 10 Tf BT 1 0 0 1 479 690.8 Tm (Timescale for )Tj ET /F1 10 Tf BT 1 0 0 1 479 678.65 Tm (action)Tj ET 0.99608 0.9451 0.76078 RG 67.32 w 31.2 617.26 m 566.2 617.26 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 652.05 m 568.4 652.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 653.13 m 30.07 583.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 653.13 m 567.32 583.6 l S 0.001 w [] 0 d /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 635.86 Tm (Statutory requirements)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 34.05 618.28 Tm (These requirements set out what the registered person must do to meet the Care )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 603.7 Tm (Standards Act 2000, )Tj ET /F1 12 Tf BT 1 0 0 1 162.09 603.7 Tm (Care Homes Regulations )Tj ET /F1 12 Tf BT 1 0 0 1 314.21 603.7 Tm (2001 and the National Minimum )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 589.12 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET 0.99608 0.9451 0.76078 RG 30.3 w 31.2 565.08 m 91 565.08 l S 0.001 w 30.3 w 93.25 565.08 m 197.4 565.08 l S 0.001 w 30.3 w 199.65 565.08 m 289.5 565.08 l S 0.001 w 30.3 w 291.75 565.08 m 473.9 565.08 l S 0.001 w 30.3 w 476.15 565.08 m 566.2 565.08 l S 0.001 w 1 1 1 RG 286.02 w 31.2 404.67 m 91.05 404.67 l S 0.001 w 286.02 w 93.3 404.67 m 197.4 404.67 l S 0.001 w 286.02 w 199.65 404.67 m 289.45 404.67 l S 0.001 w 286.02 w 291.7 404.67 m 473.8 404.67 l S 0.001 w 286.02 w 476.05 404.67 m 566.1 404.67 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 548.8 m 568.4 548.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 582.43 m 92.12 259.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 582.43 m 290.62 259.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 582.43 m 475.02 259.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 581.35 m 568.4 581.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 548.8 m 568.3 548.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 260.53 m 568.3 260.53 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 582.43 m 30.07 259.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 549.88 m 92.17 259.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 582.43 m 198.52 259.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 549.88 m 290.57 259.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 549.88 m 474.92 259.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 582.43 m 567.32 259.46 l S 0.001 w [] 0 d /F1 10 Tf BT 1 0 0 1 34.05 567.18 Tm (No.)Tj ET /F1 10 Tf BT 1 0 0 1 96.1 567.18 Tm (Standard)Tj ET /F1 10 Tf BT 1 0 0 1 202.5 567.18 Tm (Regulation)Tj ET /F1 10 Tf BT 1 0 0 1 294.6 567.18 Tm (Requirement)Tj ET /F1 10 Tf BT 1 0 0 1 479 567.18 Tm (Timescale for )Tj ET /F1 10 Tf BT 1 0 0 1 479 555.03 Tm (action)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 532.62 Tm (1)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 532.62 Tm (27)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 532.62 Tm (13)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 532.62 Tm (A competent person must be )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 518.04 Tm (asked to assess the toilet of )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 503.46 Tm (the person who sustained a )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 488.88 Tm (fall from it, to ensure it is )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 474.3 Tm (suitable and safe for the )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 459.72 Tm (persons specialist needs.)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 445.14 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 430.56 Tm (In the meantime steps must )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 415.98 Tm (be taken to reduce the risk )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 401.4 Tm (of accident or injury from the )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 386.82 Tm (toilet)Tj ET /F1 12 Tf BT 1 0 0 1 294.55 369.24 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 294.55 354.66 Tm (This will ensure that the )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 340.08 Tm (persons independence and )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 325.5 Tm (dignity is maximised along )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 310.92 Tm (with safety and the reduction )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 296.34 Tm (of any further risk and injury )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 281.76 Tm (which may be incurred from )Tj ET /F1 12 Tf BT 1 0 0 1 294.55 267.18 Tm (falling from the toilet.)Tj ET /F1 12 Tf BT 1 0 0 1 478.9 532.62 Tm (31/05/2009)Tj ET 0.99608 0.9451 0.76078 RG 67.32 w 31.2 205.37 m 566.2 205.37 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 240.16 m 568.4 240.16 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 241.24 m 30.07 171.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 241.24 m 567.32 171.71 l S 0.001 w [] 0 d /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 223.97 Tm (Recommendations)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 34.05 206.39 Tm (These recommendations are taken from the best practice described in the National )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 191.81 Tm (Minimum Standards and the registered person\(s\) should consider them as a way of )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 177.23 Tm (improving their service.)Tj ET 0.99608 0.9451 0.76078 RG 18.15 w 31.2 160.39 m 91.05 160.39 l S 0.001 w 18.15 w 93.3 160.39 m 197.4 160.39 l S 0.001 w 18.15 w 199.65 160.39 m 566.1 160.39 l S 0.001 w 1 1 1 RG 90.66 w 31.2 103.73 m 91.05 103.73 l S 0.001 w 90.66 w 93.3 103.73 m 197.4 103.73 l S 0.001 w 90.66 w 199.65 103.73 m 566.1 103.73 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 150.19 m 568.3 150.19 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 170.59 m 568.3 170.59 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 150.19 m 568.3 150.19 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 57.28 m 568.3 57.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 171.67 m 30.07 56.2 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 171.67 m 92.17 56.2 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 171.67 m 198.52 56.2 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 171.67 m 567.22 56.2 l S 0.001 w [] 0 d /F1 10 Tf BT 1 0 0 1 34.05 156.41 Tm (No.)Tj ET /F1 10 Tf BT 1 0 0 1 96.15 156.41 Tm (Refer to Standard)Tj ET /F1 10 Tf BT 1 0 0 1 202.5 156.41 Tm (Good Practice Recommendations)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 134 Tm (1)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 134 Tm (20)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 134 Tm (The home should ensure that at the start of each month it )Tj ET /F1 12 Tf BT 1 0 0 1 202.5 119.42 Tm (has an accurate record of all medications present within the )Tj ET /F1 12 Tf BT 1 0 0 1 202.5 104.84 Tm (home.)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 90.26 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 202.5 75.68 Tm (Also the home should simplify the system for checking that )Tj ET /F1 12 Tf BT 1 0 0 1 202.5 61.1 Tm (medication has been administered during the month.)Tj ET endstream endobj 29 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 31 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 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2.25 w 567.22 814.73 m 567.22 609.54 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 200.25 802.72 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 200.25 788.14 Tm (This was a new recommendation July 2008 and has been )Tj ET /F1 12 Tf BT 1 0 0 1 200.25 773.56 Tm (carried forward at this random inspection.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 748.48 Tm (2)Tj ET /F1 12 Tf BT 1 0 0 1 96.15 748.48 Tm (35)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 748.48 Tm (It is recommended that steps are taken to clearly )Tj ET /F1 12 Tf BT 1 0 0 1 202.5 733.9 Tm (differentiate practical and theoretical moving and handling )Tj ET /F1 12 Tf BT 1 0 0 1 202.5 719.32 Tm (training on the team training matrix.)Tj ET /F1 12 Tf BT 1 0 0 1 202.5 704.74 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 202.5 690.16 Tm (Systems should be employed to ensure all practical moving )Tj ET /F1 12 Tf BT 1 0 0 1 202.5 675.58 Tm (and handling training provided by the homes train the )Tj ET /F1 12 Tf BT 1 0 0 1 202.5 661 Tm (trainer, is accurately reflected in the training matrix and )Tj ET /F1 12 Tf BT 1 0 0 1 202.5 646.42 Tm (that systems are sufficiently in place to properly confirm )Tj ET /F1 12 Tf BT 1 0 0 1 202.5 631.84 Tm (attendance and that participants have achieved the )Tj ET /F1 12 Tf BT 1 0 0 1 202.5 617.26 Tm (requisite level of competence during training.)Tj ET endstream endobj 32 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 33 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F1 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 Adults \(18-65 years\))Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F1 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 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2.25 w 26.14 717.03 m 567.2 717.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 694.2 m 567.2 694.2 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.22 786.6 m 27.22 693.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 224.46 786.6 m 224.46 693.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.13 786.6 m 566.13 693.12 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 31.2 769.33 Tm (Document Purpose:)Tj ET /F1 12 Tf BT 1 0 0 1 228.43 769.33 Tm (Inspection Report)Tj ET /F1 12 Tf BT 1 0 0 1 31.2 746.5 Tm (Author:)Tj ET /F1 12 Tf BT 1 0 0 1 228.43 746.5 Tm (CSCI)Tj ET /F1 12 Tf BT 1 0 0 1 31.2 723.67 Tm (Audience:)Tj ET /F1 12 Tf BT 1 0 0 1 228.43 723.67 Tm (General Public)Tj ET /F1 12 Tf BT 1 0 0 1 31.2 700.84 Tm (Further copies from:)Tj ET /F1 12 Tf BT 1 0 0 1 228.43 700.84 Tm (0870 240 7535)Tj ET /F1 12 Tf BT 1 0 0 1 329.28 700.84 Tm (\(telephone order line\))Tj ET /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 679.89 Tm ()Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 665.31 Tm ()Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 650.73 Tm ()Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr 0.98431 0.78824 0.08627 RG 78.9 w 25.8 608.76 m 563.3 608.76 l S 0.001 w /F1 12 Tf BT 1 0 0 1 34.05 633.15 Tm (Our duty to regulate social care services is set out in the Care Standards Act 2000.)Tj ET /F1 12 Tf BT 1 0 0 1 34.05 618.57 Tm (Copies of the National Minimum Standards )Tj ET /F1 12 Tf BT 1 0 0 1 303.94 618.57 Tm (Care Homes for Adults \(18-65 years\) can )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 603.99 Tm (be found at www.dh.gov.uk or got from The Stationery Office \(TSO\) PO Box 29, St )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 589.41 Tm (Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from )Tj ET /F1 12 Tf BT 1 0 0 1 34.05 574.83 Tm (the Stationery Office is also available: www.tso.co.uk/bookshop)Tj ET /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 554.25 Tm ()Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 536.67 Tm ()Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 522.09 Tm ()Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 507.51 Tm ()Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 34.16 w 25.8 487.91 m 563.3 487.91 l S 0.001 w /F1 20 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 482.39 Tm (Helpline:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 20 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 448.23 Tm (Telephone:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 20 Tf BT 1 0 0 1 147.95 448.23 Tm (03000 616161)Tj ET /F1 20 Tf BT 1 0 0 1 301.95 448.23 Tm (or)Tj ET /F1 20 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 416.57 Tm (Textphone)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 20 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 134.15 416.57 Tm (:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 20 Tf BT 1 0 0 1 150.27 416.57 Tm (or)Tj ET /F1 20 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 384.91 Tm (Email:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 20 Tf BT 1 0 0 1 99.55 384.91 Tm (enquiries@cqc.org.uk)Tj ET /F1 20 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 353.25 Tm (Web:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 20 Tf BT 1 0 0 1 100.35 353.25 Tm (www.cqc.org.uk)Tj ET /F1 18 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 323.6 Tm ()Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 18 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 294.86 Tm ()Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 12 Tf BT 1 0 0 1 28.35 272.14 Tm (We want people to be able to access this information. If you would like a summary in a )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 254.65 Tm (different format or language please contact our helpline or go to our website.)Tj ET /F1 18 Tf BT 1 0 0 1 28.35 228.62 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 205.9 Tm (Copyright \()Tj ET /F1 12 Tf BT 1 0 0 1 112.69 205.9 Tm (2009)Tj ET /F1 12 Tf BT 1 0 0 1 143.22 205.9 Tm (\) Commission for Social Care Inspection \(CSCI\). This publication may )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 188.41 Tm (be reproduced in whole or in part, free of charge, in any format or medium provided )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 170.91 Tm (that it is not used for commercial gain. This consent is subject to the material being )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 153.42 Tm (reproduced accurately and on proviso that it is not used in a derogatory manner or )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 135.92 Tm (misleading context. The material should be acknowledged as CSCI copyright, with the )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 118.43 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 34 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 35 0 obj[29 0 R/XYZ 0 809.65 0] endobj 36 0 obj <>stream %!PS-AdobeFont-1.0: Verdana Typeface and data 1996 Microsoft Corporation. All Rights Reserved %%CreationDate: Thu Oct 09 15:25:10 2008 % Converted from TrueType font 'VERDANA.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 2.35) readonly def /Notice (Typeface and data 1996 Microsoft Corporation. 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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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