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(24)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm (A system of staff supervsion )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm (must be put in place.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (This will ensure that poor )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (practice can be addressed )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm (and monitored, and that all )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.68 Tm (staff can receive support to )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.68 Tm (perform their duties in a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 441.68 Tm (safe way for the benefit of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 424.68 Tm (the people using this )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 407.68 Tm (service.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 577.68 Tm (29/01/2010)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 577.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 388.43 Tm (21)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 388.43 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 388.43 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 388.43 Tm (All staff must receive )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 371.43 Tm (training in the protection of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 354.43 Tm (vulnerable adults, first aid, )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 337.43 Tm (infection control, and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 320.43 Tm (moving and handling)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 303.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 286.43 Tm (This will ensure that all staff )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 269.43 Tm (can work in a safe way that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 252.43 Tm (is up to date.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 388.43 Tm (12/02/2010)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 388.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 233.18 Tm (22)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 233.18 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 233.18 Tm (17)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 233.18 Tm (Accidents at the home must )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 216.18 Tm (be recorded and managed. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 199.18 Tm (All copies of accidents )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 182.18 Tm (recorded must be stored )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 165.18 Tm (safely and securely.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 148.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 131.18 Tm (This will ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 114.18 Tm (accidents can be monitored )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 97.18 Tm (for trends, and referred to if )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 80.18 Tm (needed.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 233.18 Tm (29/01/2010)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 233.18 Tm ()Tj ET endstream endobj 98 0 obj<> endobj 99 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 100 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (42)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (44)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 322.54 w 32.32 650.13 m 564.97 650.13 l S 0.001 w 1 1 1 RG 102 w 31.2 659.99 m 91.05 659.99 l S 0.001 w 102 w 93.3 659.99 m 197.4 659.99 l S 0.001 w 102 w 199.65 659.99 m 289.45 659.99 l S 0.001 w 102 w 291.7 659.99 m 473.8 659.99 l S 0.001 w 102 w 476.05 659.99 m 566.1 659.99 l S 0.001 w 119 w 31.2 547.24 m 91.05 547.24 l S 0.001 w 119 w 93.3 547.24 m 197.4 547.24 l S 0.001 w 119 w 199.65 547.24 m 289.45 547.24 l S 0.001 w 119 w 291.7 547.24 m 473.8 547.24 l S 0.001 w 119 w 476.05 547.24 m 566.1 547.24 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 607.86 m 568.3 607.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 485.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 485.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 485.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 485.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 485.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 485.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 607.86 m 568.3 607.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 486.61 m 568.3 486.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 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The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 698.93 Tm (23)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 698.93 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 698.93 Tm (37)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 698.93 Tm (The CQC must be informed )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 681.93 Tm (of any adverse events that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 664.93 Tm (occur in the home.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 647.93 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 630.93 Tm (This will ensure that we can )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 613.93 Tm (monitor events at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 698.93 Tm (29/01/2010)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 698.93 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 594.68 Tm (24)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 594.68 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 594.68 Tm (23)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.68 Tm (All fire doors must be kept )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm (shut unless held open by an )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm (approved hold-open device.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (This is to ensure that the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (people uisng this servce are )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm (protected from harm.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 594.68 Tm (29/01/2010)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 594.68 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 404.46 w 32.32 265.13 m 564.97 265.13 l S 0.001 w 1 1 1 RG 122.64 w 31.2 318.32 m 91.05 318.32 l S 0.001 w 122.64 w 93.3 318.32 m 197.4 318.32 l S 0.001 w 122.64 w 199.65 318.32 m 566.1 318.32 l S 0.001 w 49.74 w 31.2 229.88 m 91.05 229.88 l S 0.001 w 49.74 w 93.3 229.88 m 197.4 229.88 l S 0.001 w 49.74 w 199.65 229.88 m 566.1 229.88 l S 0.001 w 78.9 w 31.2 163.31 m 91.05 163.31 l S 0.001 w 78.9 w 93.3 163.31 m 197.4 163.31 l S 0.001 w 78.9 w 199.65 163.31 m 566.1 163.31 l S 0.001 w 57.59 w 31.2 92.82 m 91.05 92.82 l S 0.001 w 57.59 w 93.3 92.82 m 197.4 92.82 l S 0.001 w 57.59 w 199.65 92.82 m 566.1 92.82 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 255.88 m 568.3 255.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 203.89 m 568.3 203.89 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 122.74 m 568.3 122.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 381.85 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 381.85 m 567.22 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 400.04 m 568.4 400.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 380.77 m 568.3 380.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 381.85 m 92.17 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 381.85 m 198.52 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 469.61 m 568.4 469.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 400.04 m 568.4 400.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 255.88 m 568.3 255.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 203.89 m 568.3 203.89 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 122.74 m 568.3 122.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 568.3 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 470.69 m 30.07 379.69 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 401.12 m 92.17 380.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.47 401.12 m 198.47 380.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 470.69 m 567.32 379.69 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 453.43 Tm (Recommendations)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 435.85 Tm (These recommendations are taken from the best practice described in the National )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 421.27 Tm (Minimum Standards and the registered person\(s\) should consider them as a way of )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 406.69 Tm (improving their service.)Tj ET /F2 10 Tf BT 1 0 0 1 34.05 385.87 Tm (No)Tj ET /F2 10 Tf BT 1 0 0 1 96.15 385.87 Tm (Refer to Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.45 385.87 Tm (Good Practice Recommendations)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 364.58 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 364.58 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 364.58 Tm (It is recommended that any handwritten medicines charts )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 350 Tm (are checked and signed by two members of trained staff, )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 335.42 Tm (and that any dose changes are asked to be sent or faxed )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 320.84 Tm (through in writing. It is also recommended to have a )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 306.26 Tm (sample list of staff signatures, to be able to identify staff )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 291.68 Tm (who have given medicines to people.)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 277.1 Tm (These are to reduce the risk of any medicines errors )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 262.52 Tm (occurring.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 239.69 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 239.69 Tm (16)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 239.69 Tm (The complaints procedure should be displayed in a )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 225.11 Tm (prominent position and at a height that is easily readable )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 210.53 Tm (by everyone.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 187.7 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 187.7 Tm (33)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 187.7 Tm (An effective quality assurance system, with a summary of )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 173.12 Tm (any findings,should be put in place that actively involves )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 158.54 Tm (and seeks the views of the people using this service, their )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 143.96 Tm (friends and family, and stakeholders who have contacts )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 129.38 Tm (with the home.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 106.55 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 106.55 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 106.55 Tm (A full review of the physical environment should be )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 91.97 Tm (undertaken to ensure that signage is in place or replaced )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 77.39 Tm (where it is worn or missing. This review should also )Tj ET endstream endobj 101 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 102 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (43)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (44)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 187.57 w 32.32 717.62 m 564.97 717.62 l S 0.001 w 1 1 1 RG 17.58 w 31.2 714.89 m 91.05 714.89 l S 0.001 w 17.58 w 93.3 714.89 m 197.4 714.89 l S 0.001 w 17.58 w 199.65 714.89 m 566.1 714.89 l S 0.001 w 78.9 w 31.2 664.4 m 91.05 664.4 l S 0.001 w 78.9 w 93.3 664.4 m 197.4 664.4 l S 0.001 w 78.9 w 199.65 664.4 m 566.1 664.4 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 704.98 m 568.3 704.98 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 725.89 m 30.07 622.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 725.89 m 567.22 622.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.08 m 568.4 744.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 724.81 m 568.3 724.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 725.89 m 92.17 622.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 725.89 m 198.52 622.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.08 m 568.4 744.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 704.98 m 568.3 704.98 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 623.83 m 568.3 623.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 723.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 745.16 m 92.17 724.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.47 745.16 m 198.47 724.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 723.73 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 797.47 Tm (Recommendations)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 779.89 Tm (These recommendations are taken from the best practice described in the National )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 765.31 Tm (Minimum Standards and the registered person\(s\) should consider them as a way of )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 750.73 Tm (improving their service.)Tj ET /F2 10 Tf BT 1 0 0 1 34.05 729.91 Tm (No)Tj ET /F2 10 Tf BT 1 0 0 1 96.15 729.91 Tm (Refer to Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.45 729.91 Tm (Good Practice Recommendations)Tj ET /F2 12 Tf BT 1 0 0 1 200.25 713.87 Tm (consider providing locks for cupboards.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 688.79 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 688.79 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 688.79 Tm (An Occupational Therapist's assessment and advice about )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 674.21 Tm (the home and external grounds should be sought.This )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 659.63 Tm (would provide clear indicators about how the home could )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 645.05 Tm (be as accessible as possible for the people using the service )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 630.47 Tm (and thereby increase their independence.)Tj ET endstream endobj 103 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 104 0 obj<>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (44)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (44)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 22.5 w 22.95 802.41 m 560.45 802.41 l S 0.001 w /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 799.09 Tm (Helpline:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 28.35 781.11 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 759.6 Tm (Telephone:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 95.88 759.6 Tm ( 03000 616161)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 739.6 Tm (Email:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 66.84 739.6 Tm ( enquiries@cqc.org.uk)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 719.61 Tm (Web:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 64.35 719.61 Tm (www.cqc.org.uk)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 699.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 679.61 Tm (We want people to be able to access this information. If you would like a summary in a )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 662.12 Tm (different format or language please contact our helpline or go to our website.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 622.62 Tm (Copyright \(2009\) Care Quality Commission \(CQC\). This publication may be )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium provided that it )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 587.63 Tm (is not used for commercial gain. This consent is subject to the material being )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory manner or )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 552.64 Tm (misleading context. The material should be acknowledged as CQC copyright, with the )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 535.14 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 105 0 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>>> endobj 106 0 obj[6 0 R/XYZ 0 301.289978 0] endobj 107 0 obj<>stream  cvt gxfpgm;_glyfˬ ^head< H6hhea$ $hmtx ploca76maxp 1t prepF 8}11c1bbDu1c111D1>}1(111{-1(3c1J`7]1bP2Jb2(11124bb(()_b{8P>2;IV`bbz!&BF7>>TtNmmn{{(hxAYiU\.t/J\cx{{{ ""(/23>CFHPSfijkrsx,.88AMP\ik| ,,Alx=>o:BX~9`/111:<JJLWstx  ((-WYZZZZprr."+`x =.:WX]]SlCcM*SclAq],C]"D>;KeJPBQLQLT7Z\WU:rrE@78743210/.-,+*)('&%$#"!  ,E#F` &`&#HH-,E#F#a &a&#HH-,E#F` a F`&#HH-,E#F#a ` &a a&#HH-,E#F`@a f`&#HH-,E#F#a@` &a@a&#HH-, <<-, E# D# ZQX# D#Y QX# MD#Y &QX# D#Y!!-, EhD ` EFvhE`D-, C#Ce -, C#C -,F#pF>F#pFE: -,EJ#DEI#D-, E%EadPQXED!!Y-,Cc#b#B+-, EC`D-,CCe -, i@a ,b`+ d#da\XaY-,E+G#DGz-,TX CTXJIDDYY-,CXE+#DzEi #D QX+#Dz!zYY-,-,KRX!ED#E %ERXD!!YY-,/-, %EI#DEJ#DEe#E %`j #B#hj`a Ry!J@JE TX#!?#YaDRyI@ IE TX#!?#YaD-,C#C -,C#C -, C#C -, C#Ce -,C#Ce -,C#Ce -,KRXED!!Y-, %#I@` c RX#%8#%e8c8!!!!!Y-,Ei C`:-,%# `#-,%# a#-,%-, ` <<-, a <<-,++**-,CC -,>**-,5-,vK#p KE PXaY:/-,!! d#d@b-,!QX d#d b@/+Y`-,!QX d#dUb/+Y`-, d#d@b`#!-,&&&&Eh:-,&&&&Ehe:-,E# E %PX&a&`YD-,F#F`F# F`ab# #KKpE` PXa@Yh:-,3+**-,CXY-,CXY-#@/?103!%!!8 P@+  { /999?999/10&''&&'632!!!!67`,9) KgJ*JJ&J (""" """ zJzJee") """"!!""+ ]+PV =`9PPPP""""""""""""""""""""""kk4!!!!!!!!!!!!o!!!!!!!o!!!!!!!!!po==!!!!!!!!!!!!!!!!!!b!Q!?!.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!}!&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&`9_@ FF@H H2 %H2 #H2 "H2 !H2  H2 H2 H2 H2 @[H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 yH2 nH2 dH2 _H2 ]H2 ZH2 XH2 H2 H2 H2 H2 H2 H2 H2 @LH2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 \H2& & 7E@CzweaWU$"   KKSBKcKb S# QZ#BKKTB8+TXCXYY++++++++++++++++++++++++++++++++KPyAP*&+++++KSyAP*&+++++P2Ka`+++++++++++++++++++++++++++++++++++++++++++++++++++++++++EiSBKPXBYC\XBY CX`!YBp>CX;!~ +Y #B #BCX-A-A +Y#B#BCX~;! +Y#B#B endstream endobj 108 0 obj<> endobj 109 0 obj<>/FontDescriptor 108 0 R/DW 1000>> endobj 110 0 obj<>stream /CIDInit /ProcSet findresource begin 12 dict begin begincmap /CIDSystemInfo << /Registry (Adobe) /Ordering (UCS) /Supplement 0 >> def /CMapName /Adobe-Identity-UCS def /CMapType 2 def 1 begincodespacerange <0035><0085> endcodespacerange 2 beginbfrange <0035><0035><0052> <0085><0085><00a3> endbfrange endcmap CMapName currentdict /CMap defineresource pop end end endstream endobj 111 0 obj<>stream %!PS-AdobeFont-1.0: ArialMT Typeface The Monotype Corporation plc. 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Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: Fri Oct 10 11:48:26 2008 % Converted from TrueType font 'TIMES.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 2.76) readonly def /Notice (Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved) readonly def /FullName (Times New Roman) readonly def /FamilyName (Times New Roman) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -109 def /UnderlineThickness 49 def end readonly def /FontName /TimesNewRomanPSMT def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {-77 -216 1009 877} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /quotedbl put dup 35 /numbersign put dup 36 /dollar put dup 37 /percent put dup 38 /ampersand put dup 39 /quotesingle put dup 40 /parenleft put dup 41 /parenright put dup 42 /asterisk put dup 43 /plus put dup 44 /comma put dup 45 /hyphen put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /at put dup 65 /A put dup 66 /B put dup 67 /C put dup 68 /D put dup 69 /E put dup 70 /F put dup 71 /G put dup 72 /H put dup 73 /I put dup 74 /J put dup 75 /K put dup 76 /L put dup 77 /M put dup 78 /N put dup 79 /O put dup 80 /P put dup 81 /Q put dup 82 /R put dup 83 /S put dup 84 /T put dup 85 /U put dup 86 /V put dup 87 /W put dup 88 /X put dup 89 /Y put dup 90 /Z put dup 91 /bracketleft put dup 92 /backslash put dup 93 /bracketright put dup 94 /asciicircum put dup 95 /underscore put dup 96 /grave put dup 97 /a put dup 98 /b put dup 99 /c put dup 100 /d put dup 101 /e put dup 102 /f put dup 103 /g put dup 104 /h put dup 105 /i put dup 106 /j put dup 107 /k put dup 108 /l put dup 109 /m put dup 110 /n put dup 111 /o put dup 112 /p put dup 113 /q put dup 114 /r put dup 115 /s put dup 116 /t put dup 117 /u put dup 118 /v put dup 119 /w put dup 120 /x put dup 121 /y put dup 122 /z put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /asciitilde put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /quotesinglbase put dup 131 /florin put dup 132 /quotedblbase put dup 133 /ellipsis put dup 134 /dagger put dup 135 /daggerdbl put dup 136 /circumflex put dup 137 /perthousand put dup 138 /Scaron put dup 139 /guilsinglleft put dup 140 /OE put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /quoteleft put dup 146 /quoteright put dup 147 /quotedblleft put dup 148 /quotedblright put dup 149 /bullet put dup 150 /endash put dup 151 /emdash put dup 152 /tilde put dup 153 /trademark put dup 154 /scaron put dup 155 /guilsinglright put dup 156 /oe put dup 157 /.notdef put dup 158 /.notdef put dup 159 /Ydieresis put dup 160 /space put dup 161 /exclamdown put dup 162 /cent put dup 163 /sterling put dup 164 /currency put dup 165 /yen put dup 166 /brokenbar put dup 167 /section put dup 168 /dieresis put dup 169 /copyright put dup 170 /ordfeminine put dup 171 /guillemotleft put dup 172 /logicalnot put dup 173 /hyphen put dup 174 /registered put dup 175 /overscore put dup 176 /degree put dup 177 /plusminus put dup 178 /twosuperior put dup 179 /threesuperior put dup 180 /acute put dup 181 /mu1 put dup 182 /paragraph put dup 183 /periodcentered put dup 184 /cedilla put dup 185 /onesuperior put dup 186 /ordmasculine put dup 187 /guillemotright put dup 188 /onequarter put dup 189 /onehalf put dup 190 /threequarters put dup 191 /questiondown put dup 192 /Agrave put dup 193 /Aacute put dup 194 /Acircumflex put dup 195 /Atilde put dup 196 /Adieresis put dup 197 /Aring put dup 198 /AE put dup 199 /Ccedilla put dup 200 /Egrave put dup 201 /Eacute put dup 202 /Ecircumflex put dup 203 /Edieresis put dup 204 /Igrave put dup 205 /Iacute put dup 206 /Icircumflex put dup 207 /Idieresis put dup 208 /Eth put dup 209 /Ntilde put dup 210 /Ograve put dup 211 /Oacute put dup 212 /Ocircumflex put dup 213 /Otilde put dup 214 /Odieresis put dup 215 /multiply put dup 216 /Oslash put dup 217 /Ugrave put dup 218 /Uacute put dup 219 /Ucircumflex put dup 220 /Udieresis put dup 221 /Yacute put dup 222 /Thorn put dup 223 /germandbls put dup 224 /agrave put dup 225 /aacute put dup 226 /acircumflex put dup 227 /atilde put dup 228 /adieresis put dup 229 /aring put dup 230 /ae put dup 231 /ccedilla put dup 232 /egrave put dup 233 /eacute put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B TcJ6*]h[zeKq)ƷW0jlBIf14%B[tnqNOדe{fC;1I^7^r5=[ySwF 5ZUͧ@;J7{Phx ғ*⿅΅V1lCd3Dk9+ ~Iic*x 2YC.eKgt_"t!Ztb$~iS[xdw +P7)%g9/-awT=JK/{ Q'y!kA,7 Α$?H}Om"s*5aks*HRUufn6i?kɝ=-0X%lϧQ4ݡ`rџ~D&#&:t]=.ok &DZђԺŠRq [j@3a*42K]sjϖjG_n 4Ϛ5. *Ly^w`ܮ64r/:!?u:};ߜ`dӤJY2R'wbTCI2CRNY2uD-.Y9y:2Cʸ`ͻq5dBpQŰ: TimM;f ]+ozY0,(Fh^ GirY E W| -R̵vVP ce޾'zH+1= PU~}fIa 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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. All Rights Reserved) readonly def /FullName (Verdana) readonly def /FamilyName (Verdana) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -88 def /UnderlineThickness 59 def end readonly def /FontName /Verdana def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {-30 -207 1447 1000} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /quotedbl put dup 35 /numbersign put dup 36 /dollar put dup 37 /percent put dup 38 /ampersand put dup 39 /quotesingle put dup 40 /parenleft put dup 41 /parenright put dup 42 /asterisk put dup 43 /plus put dup 44 /comma put dup 45 /hyphen put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /at put dup 65 /A put dup 66 /B put dup 67 /C put dup 68 /D put dup 69 /E put dup 70 /F put dup 71 /G put dup 72 /H put dup 73 /I put dup 74 /J put dup 75 /K put dup 76 /L put dup 77 /M put dup 78 /N put dup 79 /O put dup 80 /P put dup 81 /Q put dup 82 /R put dup 83 /S put dup 84 /T put dup 85 /U put dup 86 /V put dup 87 /W put dup 88 /X put dup 89 /Y put dup 90 /Z put dup 91 /bracketleft put dup 92 /backslash put dup 93 /bracketright put dup 94 /asciicircum put dup 95 /underscore put dup 96 /grave put dup 97 /a put dup 98 /b put dup 99 /c put dup 100 /d put dup 101 /e put dup 102 /f put dup 103 /g put dup 104 /h put dup 105 /i put dup 106 /j put dup 107 /k put dup 108 /l put dup 109 /m put dup 110 /n put dup 111 /o put dup 112 /p put dup 113 /q put dup 114 /r put dup 115 /s put dup 116 /t put dup 117 /u put dup 118 /v put dup 119 /w put dup 120 /x put dup 121 /y put dup 122 /z put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /asciitilde put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /quotesinglbase put dup 131 /florin put dup 132 /quotedblbase put dup 133 /ellipsis put dup 134 /dagger put dup 135 /daggerdbl put dup 136 /circumflex put dup 137 /perthousand put dup 138 /Scaron put dup 139 /guilsinglleft put dup 140 /OE put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /quoteleft put dup 146 /quoteright put dup 147 /quotedblleft put dup 148 /quotedblright put dup 149 /bullet put dup 150 /endash put dup 151 /emdash put dup 152 /tilde put dup 153 /trademark put dup 154 /scaron put dup 155 /guilsinglright put dup 156 /oe put dup 157 /.notdef put dup 158 /.notdef put dup 159 /Ydieresis put dup 160 /space put dup 161 /exclamdown put dup 162 /cent put dup 163 /sterling put dup 164 /currency put dup 165 /yen put dup 166 /brokenbar put dup 167 /section put dup 168 /dieresis put dup 169 /copyright put dup 170 /ordfeminine put dup 171 /guillemotleft put dup 172 /logicalnot put dup 173 /hyphen put dup 174 /registered put dup 175 /overscore put dup 176 /degree put dup 177 /plusminus put dup 178 /twosuperior put dup 179 /threesuperior put dup 180 /acute put dup 181 /mu1 put dup 182 /paragraph put dup 183 /middot put dup 184 /cedilla put dup 185 /onesuperior put dup 186 /ordmasculine put dup 187 /guillemotright put dup 188 /onequarter put dup 189 /onehalf put dup 190 /threequarters put dup 191 /questiondown put dup 192 /Agrave put dup 193 /Aacute put dup 194 /Acircumflex put dup 195 /Atilde put dup 196 /Adieresis put dup 197 /Aring put dup 198 /AE put dup 199 /Ccedilla put dup 200 /Egrave put dup 201 /Eacute put dup 202 /Ecircumflex put dup 203 /Edieresis put dup 204 /Igrave put dup 205 /Iacute put dup 206 /Icircumflex put dup 207 /Idieresis put dup 208 /Eth put dup 209 /Ntilde put dup 210 /Ograve put dup 211 /Oacute put dup 212 /Ocircumflex put dup 213 /Otilde put dup 214 /Odieresis put dup 215 /multiply put dup 216 /Oslash put dup 217 /Ugrave put dup 218 /Uacute put dup 219 /Ucircumflex put dup 220 /Udieresis put dup 221 /Yacute put dup 222 /Thorn put dup 223 /germandbls put dup 224 /agrave put dup 225 /aacute put dup 226 /acircumflex put dup 227 /atilde put dup 228 /adieresis put dup 229 /aring put dup 230 /ae put dup 231 /ccedilla put dup 232 /egrave put dup 233 /eacute put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B Tc gPUcOx {OqqQF4-UټXODU8o\kswKami%ޗﶥB$S/1LW~'T^<T4PX+ԯ({A34.KUĖn%*R_g!g(F4%ٸD K~ɕy8e!lcx# |< -}^^i(XlŨ3K a[y3E7Oz,߉1N6+Pj)cpS-mR\7߃Ra0bRTl,SQYKO׏C8y'߭sU5d}DҰMۭT[I[(㏭AK9%+,E B`6P( :8|NoYo>XImF;:Bŀÿ Kt,!fa"X0*Im Srߋ{8w;Ҵ+DIZy41Żp m`Z# 2;7aޗ8~$6<+p Uk!i͢m~~ I[z)*a0wmNQ ^\تw?@ċ=0}Ơ6YWUfo&|*aGѤrvʧ:q9h@) 6u%sBo$N?J6(Ah:m~\ZXݐ^NR(>^;:i~f6{'Y &'W|-}犁$$S Cp`Ӎ+Wǧ`q4{W_E&9YXs1sZQ<*`(SaD~e 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Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: Fri Oct 10 11:50:06 2008 % Converted from TrueType font 'SYMBOL.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 1.60) readonly def /Notice (Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved) readonly def /FullName (Symbol) readonly def /FamilyName (Symbol) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -109 def /UnderlineThickness 49 def end readonly def /FontName /SymbolMT def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {0 -220 1113 1005} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /universal put dup 35 /numbersign put dup 36 /existential put dup 37 /percent put dup 38 /ampersand put dup 39 /suchthat put dup 40 /parenleft put dup 41 /parenright put dup 42 /asteriskmath put dup 43 /plus put dup 44 /comma put dup 45 /minus put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /congruent put dup 65 /Alpha put dup 66 /Beta put dup 67 /Chi put dup 68 /Delta put dup 69 /Epsilon put dup 70 /Phi put dup 71 /Gamma put dup 72 /Eta put dup 73 /Iota put dup 74 /theta1 put dup 75 /Kappa put dup 76 /Lambda put dup 77 /Mu put dup 78 /Nu put dup 79 /Omicron put dup 80 /Pi put dup 81 /Theta put dup 82 /Rho put dup 83 /Sigma put dup 84 /Tau put dup 85 /Upsilon put dup 86 /sigma1 put dup 87 /Omega put dup 88 /Xi put dup 89 /Psi put dup 90 /Zeta put dup 91 /bracketleft put dup 92 /therefore put dup 93 /bracketright put dup 94 /perpendicular put dup 95 /underscore put dup 96 /radicalex put dup 97 /alpha put dup 98 /beta put dup 99 /chi put dup 100 /delta put dup 101 /epsilon put dup 102 /phi put dup 103 /gamma put dup 104 /eta put dup 105 /iota put dup 106 /phi1 put dup 107 /kappa put dup 108 /lambda put dup 109 /mu put dup 110 /nu put dup 111 /omicron put dup 112 /pi put dup 113 /theta put dup 114 /rho put dup 115 /sigma put dup 116 /tau put dup 117 /upsilon put dup 118 /omega1 put dup 119 /omega put dup 120 /xi put dup 121 /psi put dup 122 /zeta put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /similar put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /.notdef put dup 131 /.notdef put dup 132 /.notdef put dup 133 /.notdef put dup 134 /.notdef put dup 135 /.notdef put dup 136 /.notdef put dup 137 /.notdef put dup 138 /.notdef put dup 139 /.notdef put dup 140 /.notdef put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /.notdef put dup 146 /.notdef put dup 147 /.notdef put dup 148 /.notdef put dup 149 /.notdef put dup 150 /.notdef put dup 151 /.notdef put dup 152 /.notdef put dup 153 /.notdef put dup 154 /.notdef put dup 155 /.notdef put dup 156 /.notdef put dup 157 /.notdef put dup 158 /.notdef put dup 159 /.notdef put dup 160 /.notdef put dup 161 /Upsilon1 put dup 162 /minute put dup 163 /lessequal put dup 164 /fraction put dup 165 /infinity put dup 166 /florin put dup 167 /club put dup 168 /diamond put dup 169 /heart put dup 170 /spade put dup 171 /arrowboth put dup 172 /arrowleft put dup 173 /arrowup put dup 174 /arrowright put dup 175 /arrowdown put dup 176 /degree put dup 177 /plusminus put dup 178 /second put dup 179 /greaterequal put dup 180 /multiply put dup 181 /proportional put dup 182 /partialdiff put dup 183 /bullet put dup 184 /divide put dup 185 /notequal put dup 186 /equivalence put dup 187 /approxequal put dup 188 /ellipsis put dup 189 /arrowvertex put dup 190 /arrowhorizex put dup 191 /carriagereturn put dup 192 /aleph put dup 193 /Ifraktur put dup 194 /Rfraktur put dup 195 /weierstrass put dup 196 /circlemultiply put dup 197 /circleplus put dup 198 /emptyset put dup 199 /intersection put dup 200 /union put dup 201 /propersuperset put dup 202 /reflexsuperset put dup 203 /notsubset put dup 204 /propersubset put dup 205 /reflexsubset put dup 206 /element put dup 207 /notelement put dup 208 /angle put dup 209 /gradient put dup 210 /registerserif put dup 211 /copyrightserif put dup 212 /trademarkserif put dup 213 /product put dup 214 /radical put dup 215 /dotmath put dup 216 /logicalnot put dup 217 /logicaland put dup 218 /logicalor put dup 219 /arrowdblboth put dup 220 /arrowdblleft put dup 221 /arrowdblup put dup 222 /arrowdblright put dup 223 /arrowdbldown put dup 224 /lozenge put dup 225 /angleleft put dup 226 /registersans put dup 227 /copyrightsans put dup 228 /trademarksans put dup 229 /summation put dup 230 /parenlefttp put dup 231 /parenleftex put dup 232 /parenleftbt put dup 233 /bracketlefttp put dup 234 /bracketleftex put dup 235 /bracketleftbt put dup 236 /bracelefttp put dup 237 /braceleftmid put dup 238 /braceleftbt put dup 239 /braceex put dup 240 /.notdef put dup 241 /angleright put dup 242 /integral put dup 243 /integraltp put dup 244 /integralex put dup 245 /integralbt put dup 246 /parenrighttp put dup 247 /parenrightex put dup 248 /parenrightbt put dup 249 /bracketrighttp put dup 250 /bracketrightex put dup 251 /bracketrightbt put dup 252 /bracerighttp put dup 253 /bracerightmid put dup 254 /bracerightbt put dup 255 /.notdef put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B T=:[RXz:F.V0zjQ 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We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 361 0 obj 5469 endobj 362 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14999 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14999 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14999 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14999 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14999 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14999 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14999 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14999 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14999 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14999 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14999 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14999 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14999 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14999 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 363 0 obj 8855 endobj 364 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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785.63 l S 28.99001 762.79999 m 567.84998 762.79999 l S 28.99001 669.64996 m 567.84998 669.64996 l S 28.99001 646.82001 m 567.84998 646.82001 l S 28.99001 623.98999 m 567.84998 623.98999 l S 28.99001 601.15997 m 567.84998 601.15997 l S 28.99001 578.33002 m 567.84998 578.33002 l S 30.07001 786.70996 m 30.07001 577.26001 l S 269.07001 786.70996 m 269.07001 577.26001 l S 566.76996 786.70996 m 566.76996 577.26001 l S BT /T1_0 12 Tf 1 0 0 1 34.05 769.45001 Tm (Name of care home:)Tj 1 0 0 1 273.04999 769.45001 Tm (The Manor House)Tj 1 0 0 1 34.05 746.62 Tm (Address:)Tj 1 0 0 1 273.04999 746.62 Tm (135 Loosleigh Lane)Tj 1 0 0 1 273.04999 729.03998 Tm (Derriford)Tj 1 0 0 1 273.04999 711.45996 Tm (Plymouth)Tj 1 0 0 1 273.04999 693.88 Tm (Devon)Tj 1 0 0 1 273.04999 676.29999 Tm (PL6 5JE)Tj 1 0 0 1 34.05 653.46997 Tm (Telephone number:)Tj 1 0 0 1 273.04999 653.46997 Tm (01752777572)Tj 1 0 0 1 34.05 630.64001 Tm (Fax number:)Tj 1 0 0 1 273.04999 630.64001 Tm (01572776628)Tj 1 0 0 1 34.05 607.81 Tm (Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87997 m 353.25 500.87997 l S 1 1 1 RG 355.5 500.87997 m 565.90002 500.87997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38998 l S 354.37 559.02997 m 354.37 488.38998 l S 567.01996 559.02997 m 567.01996 488.38998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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applicable\):)Tj 1 0 0 1 302.30002 392.5 Tm (Under 65)Tj 1 0 0 1 435.37 392.5 Tm (Over 65)Tj ET 1 1 1 RG 20.58 w 31.2 371.06 m 297.30002 371.06 l S 299.54999 371.06 m 431.44998 371.06 l S 433.70001 371.06 m 565.60004 371.06 l S 35.16 w 31.2 340.94 m 297.30002 340.94 l S 299.54999 340.94 m 431.44998 340.94 l S 433.70001 340.94 m 565.60004 340.94 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 310.82001 m 565.60004 310.82001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 567.79999 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 382.47998 m 567.79999 382.47998 l S 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 568.10004 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 210.00999 m 568.10004 210.00999 l S 30.07001 383.54999 m 30.07001 208.92999 l S 298.41998 383.54999 m 298.41998 321.16 l S 432.56998 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The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 365 0 obj 2934 endobj 366 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 367 0 obj 3668 endobj 368 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28999 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50999 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31999 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14999 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 369 0 obj 1865 endobj 370 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 371 0 obj 6632 endobj 372 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89999 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03999 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 373 0 obj 5629 endobj 374 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37997 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67999 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 375 0 obj 1466 endobj 376 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 377 0 obj 1804 endobj 378 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 379 0 obj 6050 endobj 380 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16998 l S 564.77997 716.82996 m 564.77997 506.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95999 m 565.87 249.95999 l S 32.35001 251.03999 m 32.35001 78.70001 l S 564.78998 251.03999 m 564.78998 78.70001 l S 32.35001 249.95999 m 564.78998 249.95999 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78999 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 381 0 obj 3970 endobj 382 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37997 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 383 0 obj 5601 endobj 384 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81999 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14999 l S 564.78998 453.88 m 564.78998 225.14999 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28999 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03999 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 385 0 obj 5363 endobj 386 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 387 0 obj 5105 endobj 388 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 389 0 obj 1350 endobj 390 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 391 0 obj 5799 endobj 392 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16998 m 564.78998 499.16998 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87997 m 32.35001 329.13 l S 564.78998 487.87997 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78999 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28999 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78999 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 393 0 obj 5325 endobj 394 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 395 0 obj 4303 endobj 396 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 397 0 obj 5693 endobj 398 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31999 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 399 0 obj 1319 endobj 400 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 401 0 obj 5584 endobj 402 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78999 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 403 0 obj 5389 endobj 404 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 405 0 obj 2300 endobj 406 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81999 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 407 0 obj 5735 endobj 408 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81999 w 34.60001 201.42999 m 562.53998 201.42999 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78999 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 409 0 obj 5318 endobj 410 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 411 0 obj 5389 endobj 412 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 413 0 obj 2531 endobj 414 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 415 0 obj 5756 endobj 416 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50999 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78999 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28999 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 417 0 obj 5301 endobj 418 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 419 0 obj 5063 endobj 420 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 421 0 obj 3690 endobj 422 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 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567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89999 599.48999 Tm (\240)Tj ET endstream endobj 423 0 obj 6356 endobj 424 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64999 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89999 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64999 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64999 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64999 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 0.75294 0.75294 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Walker)Tj 1 0 0 1 329.63 227.14998 Tm (0)Tj 1 0 0 1 360.94998 227.14998 Tm (9)Tj 1 0 0 1 392.28 227.14998 Tm (1)Tj 1 0 0 1 423.60999 227.14998 Tm (2)Tj 1 0 0 1 454.94998 227.14998 Tm (2)Tj 1 0 0 1 486.28 227.14998 Tm (0)Tj 1 0 0 1 517.60004 227.14998 Tm (0)Tj 1 0 0 1 548.95996 227.14998 Tm (9)Tj /C2_1 10 Tf 1 0 0 1 28.35001 208.25 Tm <0003>Tj 1 0 0 1 28.35001 191.25 Tm <0003>Tj /C2_0 10 Tf 1 0 0 1 297.63998 174.25 Tm <0003>Tj 1 0 0 1 297.63998 162.17999 Tm <0003>Tj 1 0 0 1 297.63998 150.12 Tm <0003>Tj ET endstream endobj 439 0 obj 5623 endobj 440 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 441 0 obj 5469 endobj 442 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 443 0 obj 8855 endobj 444 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 774.21997 m 267.94998 774.21997 l S 1 1 1 RG 270.20001 774.21997 m 565.64996 774.21997 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 716.22998 m 267.94998 716.22998 l S 1 1 1 RG 270.20001 716.22998 m 565.64996 716.22998 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 658.23999 m 267.94998 658.23999 l S 1 1 1 RG 270.20001 658.23999 m 565.64996 658.23999 l S 0.95294 0.95294 0.95294 RG 31.2 635.40997 m 267.94998 635.40997 l S 1 1 1 RG 270.20001 635.40997 m 565.64996 635.40997 l S 0.95294 0.95294 0.95294 RG 31.2 612.57996 m 267.94998 612.57996 l S 1 1 1 RG 270.20001 612.57996 m 565.64996 612.57996 l S 0.95294 0.95294 0.95294 RG 31.2 589.75 m 267.94998 589.75 l S 1 1 1 RG 270.20001 589.75 m 565.64996 589.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 762.79999 m 567.84998 762.79999 l S 28.99001 669.64996 m 567.84998 669.64996 l S 28.99001 646.82001 m 567.84998 646.82001 l S 28.99001 623.98999 m 567.84998 623.98999 l S 28.99001 601.15997 m 567.84998 601.15997 l S 28.99001 785.63 m 567.84998 785.63 l S 28.99001 762.79999 m 567.84998 762.79999 l S 28.99001 669.64996 m 567.84998 669.64996 l S 28.99001 646.82001 m 567.84998 646.82001 l S 28.99001 623.98999 m 567.84998 623.98999 l S 28.99001 601.15997 m 567.84998 601.15997 l S 28.99001 578.33002 m 567.84998 578.33002 l S 30.07001 786.70996 m 30.07001 577.26001 l S 269.07001 786.70996 m 269.07001 577.26001 l S 566.76996 786.70996 m 566.76996 577.26001 l S BT /T1_0 12 Tf 1 0 0 1 34.05 769.45001 Tm (Name of care home:)Tj 1 0 0 1 273.04999 769.45001 Tm (The Manor House)Tj 1 0 0 1 34.05 746.62 Tm (Address:)Tj 1 0 0 1 273.04999 746.62 Tm (135 Loosleigh Lane)Tj 1 0 0 1 273.04999 729.03998 Tm (Derriford)Tj 1 0 0 1 273.04999 711.45996 Tm (Plymouth)Tj 1 0 0 1 273.04999 693.88 Tm (Devon)Tj 1 0 0 1 273.04999 676.29999 Tm (PL6 5JE)Tj 1 0 0 1 34.05 653.46997 Tm (Telephone number:)Tj 1 0 0 1 273.04999 653.46997 Tm (01752777572)Tj 1 0 0 1 34.05 630.64001 Tm (Fax number:)Tj 1 0 0 1 273.04999 630.64001 Tm (01572776628)Tj 1 0 0 1 34.05 607.81 Tm (Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87994 m 353.25 500.87994 l S 1 1 1 RG 355.5 500.87994 m 565.90002 500.87994 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38995 l S 354.37 559.02997 m 354.37 488.38995 l S 567.01996 559.02997 m 567.01996 488.38995 l S BT /T1_0 12 Tf 1 0 0 1 34.05 541.76996 Tm (Name of registered provider\(s\):)Tj 1 0 0 1 355.5 541.76996 Tm (South West Care Homes Limited)Tj 1 0 0 1 34.05 518.94 Tm (Type of registration:)Tj 1 0 0 1 358.35001 518.94 Tm (care home)Tj 1 0 0 1 34.05 496.10999 Tm (Number of places registered:)Tj 1 0 0 1 358.35001 496.10999 Tm (30)Tj /T1_0 10 Tf 1 0 0 1 28.35001 477.16998 Tm (\240)Tj 1 0 0 1 28.35001 460.16998 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 63.99001 w 32.32001 417.84998 m 564.46997 417.84998 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 429.25998 m 567.79999 429.25998 l S 28.99001 452.09 m 567.79999 452.09 l S 28.99001 429.25998 m 567.79999 429.25998 l S 28.99001 385.85001 m 567.79999 385.85001 l S 30.07001 453.16998 m 30.07001 384.76999 l S 298.32001 430.34 m 298.32001 384.76999 l S 566.71997 453.16998 m 566.71997 384.76999 l S BT /T1_0 12 Tf 1 0 0 1 34.05 435.91 Tm (Conditions of registration:)Tj 1 0 0 1 34.05 413.07999 Tm (Category\(ies\) :)Tj 1 0 0 1 302.30002 413.07999 Tm (Number of places \(if applicable\):)Tj 1 0 0 1 302.30002 392.5 Tm (Under 65)Tj 1 0 0 1 435.37 392.5 Tm (Over 65)Tj ET 1 1 1 RG 20.58 w 31.2 371.06 m 297.30002 371.06 l S 299.54999 371.06 m 431.44998 371.06 l S 433.70001 371.06 m 565.60004 371.06 l S 35.16 w 31.2 340.94 m 297.30002 340.94 l S 299.54999 340.94 m 431.44998 340.94 l S 433.70001 340.94 m 565.60004 340.94 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 310.82001 m 565.60004 310.82001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 567.79999 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 382.47998 m 567.79999 382.47998 l S 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 568.10004 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 210.00998 m 568.10004 210.00998 l S 30.07001 383.54999 m 30.07001 208.92998 l S 298.41998 383.54999 m 298.41998 321.16 l S 432.56998 383.54999 m 432.56998 321.16 l S 566.71997 383.54999 m 566.71997 208.92998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 366.28998 Tm (dementia)Tj 1 0 0 1 302.39999 366.28998 Tm (30)Tj 1 0 0 1 436.54999 366.28998 Tm (0)Tj 1 0 0 1 34.05 343.45999 Tm (old age, not falling within any other )Tj 1 0 0 1 34.05 328.88 Tm (category)Tj 1 0 0 1 302.39999 343.45999 Tm (0)Tj 1 0 0 1 436.54999 343.45999 Tm (30)Tj 1 0 0 1 34.05 306.04999 Tm (Additional conditions: )Tj 1 0 0 1 34.05 283.22 Tm (The maximum number of service users who can be accommodated is 30)Tj 1 0 0 1 34.05 260.38998 Tm (The registered person may provide the following category of service only\ : Care Home )Tj 1 0 0 1 34.05 245.81 Tm (only - Code PC to service users of either gender whose primary care need\ s are within )Tj 1 0 0 1 34.05 231.23 Tm (the following categories: Old age, not falling within any other catetgor\ y \(Code OP\) )Tj 1 0 0 1 34.05 216.64998 Tm (Dementia \(Code DE\))Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 195.22 m 315.25 195.22 l S 1 1 1 RG 317.5 195.22 m 346.54999 195.22 l S 348.80002 195.22 m 377.89999 195.22 l S 380.14999 195.22 m 409.20001 195.22 l S 411.44998 195.22 m 440.54999 195.22 l S 442.80002 195.22 m 471.89996 195.22 l S 474.14996 195.22 m 503.20001 195.22 l S 505.44998 195.22 m 534.54999 195.22 l S 536.79999 195.22 m 565.90002 195.22 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 206.62999 m 568.10004 206.62999 l S 28.99001 183.8 m 568.10004 183.8 l S 30.07001 207.70999 m 30.07001 182.73 l S 316.37 207.70999 m 316.37 182.73 l S 347.66998 207.70999 m 347.66998 182.73 l S 379.01999 207.70999 m 379.01999 182.73 l S 410.31998 207.70999 m 410.31998 182.73 l S 441.66998 207.70999 m 441.66998 182.73 l S 473.01999 207.70999 m 473.01999 182.73 l S 504.31998 207.70999 m 504.31998 182.73 l S 535.66998 207.70999 m 535.66998 182.73 l S 567.01996 207.70999 m 567.01996 182.73 l S BT /T1_0 12 Tf 1 0 0 1 34.05 190.45 Tm (Date of last inspection)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 171.92999 m 565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 445 0 obj 2934 endobj 446 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 447 0 obj 3668 endobj 448 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 449 0 obj 1865 endobj 450 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 451 0 obj 6632 endobj 452 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89996 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 453 0 obj 5629 endobj 454 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37994 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 455 0 obj 1466 endobj 456 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 457 0 obj 1804 endobj 458 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 459 0 obj 6050 endobj 460 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 461 0 obj 3970 endobj 462 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37994 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 463 0 obj 5601 endobj 464 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 465 0 obj 5363 endobj 466 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 467 0 obj 5105 endobj 468 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 469 0 obj 1350 endobj 470 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 471 0 obj 5799 endobj 472 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87994 m 32.35001 329.13 l S 564.78998 487.87994 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 473 0 obj 5325 endobj 474 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 475 0 obj 4303 endobj 476 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 477 0 obj 5693 endobj 478 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 479 0 obj 1319 endobj 480 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 481 0 obj 5584 endobj 482 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 483 0 obj 5389 endobj 484 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 485 0 obj 2300 endobj 486 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 487 0 obj 5735 endobj 488 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 489 0 obj 5318 endobj 490 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 491 0 obj 5389 endobj 492 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 493 0 obj 2531 endobj 494 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 495 0 obj 5756 endobj 496 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 497 0 obj 5301 endobj 498 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 499 0 obj 5063 endobj 500 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 501 0 obj 3690 endobj 502 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 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567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89996 599.48999 Tm (\240)Tj ET endstream endobj 503 0 obj 6356 endobj 504 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89996 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 0.75294 0.75294 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/T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 520 0 obj 5469 endobj 521 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 522 0 obj 8855 endobj 523 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87991 m 353.25 500.87991 l S 1 1 1 RG 355.5 500.87991 m 565.90002 500.87991 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38992 l S 354.37 559.02997 m 354.37 488.38992 l S 567.01996 559.02997 m 567.01996 488.38992 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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applicable\):)Tj 1 0 0 1 302.30002 392.5 Tm (Under 65)Tj 1 0 0 1 435.37 392.5 Tm (Over 65)Tj ET 1 1 1 RG 20.58 w 31.2 371.06 m 297.30002 371.06 l S 299.54999 371.06 m 431.44998 371.06 l S 433.70001 371.06 m 565.60004 371.06 l S 35.16 w 31.2 340.94 m 297.30002 340.94 l S 299.54999 340.94 m 431.44998 340.94 l S 433.70001 340.94 m 565.60004 340.94 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 310.82001 m 565.60004 310.82001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 567.79999 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 382.47998 m 567.79999 382.47998 l S 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 568.10004 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 210.00998 m 568.10004 210.00998 l S 30.07001 383.54999 m 30.07001 208.92998 l S 298.41998 383.54999 m 298.41998 321.16 l S 432.56998 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565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 524 0 obj 2934 endobj 525 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 526 0 obj 3668 endobj 527 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 528 0 obj 1865 endobj 529 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 530 0 obj 6632 endobj 531 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 532 0 obj 5629 endobj 533 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 534 0 obj 1466 endobj 535 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 536 0 obj 1804 endobj 537 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 538 0 obj 6050 endobj 539 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 540 0 obj 3970 endobj 541 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37991 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 542 0 obj 5601 endobj 543 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 544 0 obj 5363 endobj 545 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 546 0 obj 5105 endobj 547 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 548 0 obj 1350 endobj 549 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 550 0 obj 5799 endobj 551 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87991 m 32.35001 329.13 l S 564.78998 487.87991 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 552 0 obj 5325 endobj 553 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 554 0 obj 4303 endobj 555 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 556 0 obj 5693 endobj 557 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 558 0 obj 1319 endobj 559 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 560 0 obj 5584 endobj 561 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 562 0 obj 5389 endobj 563 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 564 0 obj 2300 endobj 565 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 566 0 obj 5735 endobj 567 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 568 0 obj 5318 endobj 569 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 570 0 obj 5389 endobj 571 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 572 0 obj 2531 endobj 573 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 574 0 obj 5756 endobj 575 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 576 0 obj 5301 endobj 577 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 578 0 obj 5063 endobj 579 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 580 0 obj 3690 endobj 581 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 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We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. 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Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 746 0 obj 8855 endobj 747 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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315.25 195.22 l S 1 1 1 RG 317.5 195.22 m 346.54999 195.22 l S 348.80002 195.22 m 377.89999 195.22 l S 380.14999 195.22 m 409.20001 195.22 l S 411.44998 195.22 m 440.54999 195.22 l S 442.80002 195.22 m 471.89993 195.22 l S 474.14993 195.22 m 503.20001 195.22 l S 505.44998 195.22 m 534.54999 195.22 l S 536.79999 195.22 m 565.90002 195.22 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 206.62999 m 568.10004 206.62999 l S 28.99001 183.8 m 568.10004 183.8 l S 30.07001 207.70999 m 30.07001 182.73 l S 316.37 207.70999 m 316.37 182.73 l S 347.66998 207.70999 m 347.66998 182.73 l S 379.01999 207.70999 m 379.01999 182.73 l S 410.31998 207.70999 m 410.31998 182.73 l S 441.66998 207.70999 m 441.66998 182.73 l S 473.01999 207.70999 m 473.01999 182.73 l S 504.31998 207.70999 m 504.31998 182.73 l S 535.66998 207.70999 m 535.66998 182.73 l S 567.01996 207.70999 m 567.01996 182.73 l S BT /T1_0 12 Tf 1 0 0 1 34.05 190.45 Tm (Date of last inspection)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 171.92999 m 565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 748 0 obj 2934 endobj 749 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 750 0 obj 3668 endobj 751 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 752 0 obj 1865 endobj 753 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 754 0 obj 6632 endobj 755 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 756 0 obj 5629 endobj 757 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 758 0 obj 1466 endobj 759 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 760 0 obj 1804 endobj 761 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 762 0 obj 6050 endobj 763 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 764 0 obj 3970 endobj 765 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37988 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 766 0 obj 5601 endobj 767 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 768 0 obj 5363 endobj 769 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 770 0 obj 5105 endobj 771 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 772 0 obj 1350 endobj 773 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 774 0 obj 5799 endobj 775 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 776 0 obj 5325 endobj 777 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 778 0 obj 4303 endobj 779 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 780 0 obj 5693 endobj 781 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 782 0 obj 1319 endobj 783 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 784 0 obj 5584 endobj 785 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 786 0 obj 5389 endobj 787 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 788 0 obj 2300 endobj 789 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 790 0 obj 5735 endobj 791 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 792 0 obj 5318 endobj 793 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 794 0 obj 5389 endobj 795 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 796 0 obj 2531 endobj 797 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 798 0 obj 5756 endobj 799 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 800 0 obj 5301 endobj 801 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 802 0 obj 5063 endobj 803 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 804 0 obj 3690 endobj 805 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 494.10001 784.77997 l S 0.95294 0.95294 0.95294 RG 496.34998 784.77997 m 539.10004 784.77997 l S 1 1 1 RG 541.34998 784.77997 m 566.10004 784.77997 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 794.40002 m 568.29999 794.40002 l S 26.14 813.64996 m 568.29999 813.64996 l S 26.14 794.40002 m 568.29999 794.40002 l S 26.14 775.14996 m 568.29999 775.14996 l S 27.22 814.72998 m 27.22 774.07996 l S 423.22 795.47998 m 423.22 774.07996 l S 468.22 795.47998 m 468.22 774.07996 l S 495.22 795.47998 m 495.22 774.07996 l S 540.21997 795.47998 m 540.21997 774.07996 l S 567.21997 814.72998 m 567.21997 774.07996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 33.75 800.46997 Tm (Are there any outstanding requirements from the last inspection?)Tj 1 0 0 1 429.75 781.21997 Tm (Yes)Tj /C2_0 12 Tf 1 0 0 1 476.37 783.15997 Tm <0085>Tj /T1_0 12 Tf 1 0 0 1 501.75 781.21997 Tm (No)Tj /C2_0 12 Tf 1 0 0 1 548.37 783.15997 Tm <0035>Tj ET 0.95294 0.95294 0.95294 RG 124.56 w 32.32001 655.12 m 564.96997 655.12 l S 1 1 1 RG 20.58 w 31.2 604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 806 0 obj 6356 endobj 807 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 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The registered person\(s\) must do this within the timescales\ we have set.)Tj /T1_0 10 Tf 1 0 0 1 31.2 733.48999 Tm (No.)Tj 1 0 0 1 96.10001 730.48999 Tm (Standard)Tj 1 0 0 1 202.5 730.48999 Tm (Regulation)Tj 1 0 0 1 294.60001 730.48999 Tm (Requirement)Tj 1 0 0 1 479 730.48999 Tm (Timescale for )Tj 1 0 0 1 479 718.33997 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 698.92999 Tm (23)Tj 1 0 0 1 99.3 698.92999 Tm (38)Tj 1 0 0 1 201.55 698.92999 Tm (37)Tj 1 0 0 1 298.04999 698.92999 Tm (The CQC must be informed )Tj 1 0 0 1 298.04999 681.92999 Tm (of any adverse events that )Tj 1 0 0 1 298.04999 664.92999 Tm (occur in the home.)Tj 1 0 0 1 298.04999 647.92999 Tm (\240)Tj 1 0 0 1 298.04999 630.92999 Tm (This will ensure that we can )Tj 1 0 0 1 298.04999 613.92999 Tm (monitor events at the home.)Tj 1 0 0 1 482.10001 698.92999 Tm (29/01/2010)Tj 1 0 0 1 554.04999 698.92999 Tm (\240)Tj 1 0 0 1 35.5 594.67999 Tm (24)Tj 1 0 0 1 99.3 594.67999 Tm (38)Tj 1 0 0 1 201.55 594.67999 Tm (23)Tj 1 0 0 1 298.04999 594.67999 Tm (All fire doors must be kept )Tj 1 0 0 1 298.04999 577.67999 Tm (shut unless held open by an )Tj 1 0 0 1 298.04999 560.67999 Tm (approved hold-open device.)Tj 1 0 0 1 298.04999 543.67999 Tm (\240)Tj 1 0 0 1 298.04999 526.67999 Tm (This is to ensure that the )Tj 1 0 0 1 298.04999 509.67999 Tm (people uisng this servce are )Tj 1 0 0 1 298.04999 492.67999 Tm (protected from harm.)Tj 1 0 0 1 482.10001 594.67999 Tm (29/01/2010)Tj 1 0 0 1 554.04999 594.67999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 404.45999 w 32.32001 265.13 m 564.96997 265.13 l S 1 1 1 RG 122.64 w 31.2 318.32001 m 91.05 318.32001 l S 93.3 318.32001 m 197.40001 318.32001 l S 199.64999 318.32001 m 566.10004 318.32001 l S 49.74001 w 31.2 229.87999 m 91.05 229.87999 l S 93.3 229.87999 m 197.40001 229.87999 l S 199.64999 229.87999 m 566.10004 229.87999 l S 78.90001 w 31.2 163.31 m 91.05 163.31 l S 93.3 163.31 m 197.40001 163.31 l S 199.64999 163.31 m 566.10004 163.31 l S 57.59 w 31.2 92.82001 m 91.05 92.82001 l S 93.3 92.82001 m 197.40001 92.82001 l S 199.64999 92.82001 m 566.10004 92.82001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 255.87999 m 568.29999 255.87999 l S 28.99001 203.89 m 568.29999 203.89 l S 28.99001 122.74001 m 568.29999 122.74001 l S 30.07001 381.85001 m 30.07001 61.82001 l S 567.21997 381.85001 m 567.21997 61.82001 l S 28.99001 400.03998 m 568.40002 400.03998 l S 28.99001 380.76999 m 568.29999 380.76999 l S 92.17 381.85001 m 92.17 61.82001 l S 198.51999 381.85001 m 198.51999 61.82001 l S 28.99001 469.60999 m 568.40002 469.60999 l S 28.99001 400.03998 m 568.40002 400.03998 l S 28.99001 255.87999 m 568.29999 255.87999 l S 28.99001 203.89 m 568.29999 203.89 l S 28.99001 122.74001 m 568.29999 122.74001 l S 28.99001 62.90001 m 568.29999 62.90001 l S 30.07001 470.69 m 30.07001 379.69 l S 92.17 401.12 m 92.17 380.76999 l S 198.47 401.12 m 198.47 380.76999 l S 567.32001 470.69 m 567.32001 379.69 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 453.42999 Tm (Recommendations)Tj 0 Tr 1 0 0 1 34.05 435.84998 Tm (These recommendations are taken from the best practice described in the \ National )Tj 1 0 0 1 34.05 421.26999 Tm (Minimum Standards and the registered person\(s\) should consider them as\ a way of )Tj 1 0 0 1 34.05 406.69 Tm (improving their service.)Tj /T1_0 10 Tf 1 0 0 1 34.05 385.87 Tm (No)Tj 1 0 0 1 96.15001 385.87 Tm (Refer to Standard)Tj 1 0 0 1 202.45 385.87 Tm (Good Practice Recommendations)Tj /T1_0 12 Tf 1 0 0 1 34.05 364.57999 Tm (1)Tj 1 0 0 1 96.15001 364.57999 Tm (9)Tj 1 0 0 1 202.5 364.57999 Tm (It is recommended that any handwritten medicines charts )Tj 1 0 0 1 202.5 350 Tm (are checked and signed by two members of trained staff, )Tj 1 0 0 1 202.5 335.41998 Tm (and that any dose changes are asked to be sent or faxed )Tj 1 0 0 1 202.5 320.84 Tm (through in writing. It is also recommended to have a )Tj 1 0 0 1 202.5 306.25998 Tm (sample list of staff signatures, to be able to identify staff )Tj 1 0 0 1 202.5 291.67999 Tm (who have given medicines to people.)Tj 1 0 0 1 202.5 277.10001 Tm (These are to reduce the risk of any medicines errors )Tj 1 0 0 1 202.5 262.51999 Tm (occurring.)Tj 1 0 0 1 34.05 239.68999 Tm (2)Tj 1 0 0 1 96.15001 239.68999 Tm (16)Tj 1 0 0 1 202.5 239.68999 Tm (The complaints procedure should be displayed in a )Tj 1 0 0 1 202.5 225.11 Tm (prominent position and at a height that is easily readable )Tj 1 0 0 1 202.5 210.53 Tm (by everyone.)Tj 1 0 0 1 34.05 187.7 Tm (3)Tj 1 0 0 1 96.15001 187.7 Tm (33)Tj 1 0 0 1 202.5 187.7 Tm (An effective quality assurance system, with a summary of )Tj 1 0 0 1 202.5 173.12 Tm (any findings,should be put in place that actively involves )Tj 1 0 0 1 202.5 158.53999 Tm (and seeks the views of the people using this service, their )Tj 1 0 0 1 202.5 143.95999 Tm (friends and family, and stakeholders who have contacts )Tj 1 0 0 1 202.5 129.37999 Tm (with the home.)Tj 1 0 0 1 34.05 106.55 Tm (4)Tj 1 0 0 1 96.15001 106.55 Tm (38)Tj 1 0 0 1 202.5 106.55 Tm (A full review of the physical environment should be )Tj 1 0 0 1 202.5 91.97 Tm (undertaken to ensure that signage is in place or replaced )Tj 1 0 0 1 202.5 77.39 Tm (where it is worn or missing. 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 828 0 obj 4650 endobj 829 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 461.31998 m 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l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 832 0 obj 5469 endobj 833 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 834 0 obj 8855 endobj 835 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 836 0 obj 2934 endobj 837 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 838 0 obj 3668 endobj 839 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 840 0 obj 1865 endobj 841 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 842 0 obj 6632 endobj 843 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 844 0 obj 5629 endobj 845 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 846 0 obj 1466 endobj 847 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 848 0 obj 1804 endobj 849 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 850 0 obj 6050 endobj 851 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 852 0 obj 3970 endobj 853 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 854 0 obj 5601 endobj 855 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 856 0 obj 5363 endobj 857 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 858 0 obj 5105 endobj 859 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 860 0 obj 1350 endobj 861 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 862 0 obj 5799 endobj 863 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 864 0 obj 5325 endobj 865 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 866 0 obj 4303 endobj 867 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 868 0 obj 5693 endobj 869 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 870 0 obj 1319 endobj 871 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 872 0 obj 5584 endobj 873 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 874 0 obj 5389 endobj 875 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 876 0 obj 2300 endobj 877 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 878 0 obj 5735 endobj 879 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 880 0 obj 5318 endobj 881 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 882 0 obj 5389 endobj 883 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 884 0 obj 2531 endobj 885 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 886 0 obj 5756 endobj 887 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 888 0 obj 5301 endobj 889 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 890 0 obj 5063 endobj 891 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 892 0 obj 3690 endobj 893 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 494.10001 784.77997 l S 0.95294 0.95294 0.95294 RG 496.34998 784.77997 m 539.10004 784.77997 l S 1 1 1 RG 541.34998 784.77997 m 566.10004 784.77997 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 794.40002 m 568.29999 794.40002 l S 26.14 813.64996 m 568.29999 813.64996 l S 26.14 794.40002 m 568.29999 794.40002 l S 26.14 775.14996 m 568.29999 775.14996 l S 27.22 814.72998 m 27.22 774.07996 l S 423.22 795.47998 m 423.22 774.07996 l S 468.22 795.47998 m 468.22 774.07996 l S 495.22 795.47998 m 495.22 774.07996 l S 540.21997 795.47998 m 540.21997 774.07996 l S 567.21997 814.72998 m 567.21997 774.07996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 33.75 800.46997 Tm (Are there any outstanding requirements from the last inspection?)Tj 1 0 0 1 429.75 781.21997 Tm (Yes)Tj /C2_0 12 Tf 1 0 0 1 476.37 783.15997 Tm <0085>Tj /T1_0 12 Tf 1 0 0 1 501.75 781.21997 Tm (No)Tj /C2_0 12 Tf 1 0 0 1 548.37 783.15997 Tm <0035>Tj ET 0.95294 0.95294 0.95294 RG 124.56 w 32.32001 655.12 m 564.96997 655.12 l S 1 1 1 RG 20.58 w 31.2 604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 894 0 obj 6356 endobj 895 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 0.75294 0.75294 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 916 0 obj 4650 endobj 917 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 461.31998 m 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l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 920 0 obj 5469 endobj 921 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 922 0 obj 8855 endobj 923 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 924 0 obj 2934 endobj 925 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 926 0 obj 3668 endobj 927 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 928 0 obj 1865 endobj 929 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 930 0 obj 6632 endobj 931 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 932 0 obj 5629 endobj 933 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 934 0 obj 1466 endobj 935 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 936 0 obj 1804 endobj 937 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 938 0 obj 6050 endobj 939 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 940 0 obj 3970 endobj 941 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 942 0 obj 5601 endobj 943 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 944 0 obj 5363 endobj 945 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 946 0 obj 5105 endobj 947 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 948 0 obj 1350 endobj 949 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 950 0 obj 5799 endobj 951 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 952 0 obj 5325 endobj 953 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 954 0 obj 4303 endobj 955 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 956 0 obj 5693 endobj 957 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 958 0 obj 1319 endobj 959 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 960 0 obj 5584 endobj 961 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 962 0 obj 5389 endobj 963 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 964 0 obj 2300 endobj 965 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 966 0 obj 5735 endobj 967 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 968 0 obj 5318 endobj 969 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 970 0 obj 5389 endobj 971 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 972 0 obj 2531 endobj 973 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 974 0 obj 5756 endobj 975 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 976 0 obj 5301 endobj 977 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 978 0 obj 5063 endobj 979 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 980 0 obj 3690 endobj 981 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 494.10001 784.77997 l S 0.95294 0.95294 0.95294 RG 496.34998 784.77997 m 539.10004 784.77997 l S 1 1 1 RG 541.34998 784.77997 m 566.10004 784.77997 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 794.40002 m 568.29999 794.40002 l S 26.14 813.64996 m 568.29999 813.64996 l S 26.14 794.40002 m 568.29999 794.40002 l S 26.14 775.14996 m 568.29999 775.14996 l S 27.22 814.72998 m 27.22 774.07996 l S 423.22 795.47998 m 423.22 774.07996 l S 468.22 795.47998 m 468.22 774.07996 l S 495.22 795.47998 m 495.22 774.07996 l S 540.21997 795.47998 m 540.21997 774.07996 l S 567.21997 814.72998 m 567.21997 774.07996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 33.75 800.46997 Tm (Are there any outstanding requirements from the last inspection?)Tj 1 0 0 1 429.75 781.21997 Tm (Yes)Tj /C2_0 12 Tf 1 0 0 1 476.37 783.15997 Tm <0085>Tj /T1_0 12 Tf 1 0 0 1 501.75 781.21997 Tm (No)Tj /C2_0 12 Tf 1 0 0 1 548.37 783.15997 Tm <0035>Tj ET 0.95294 0.95294 0.95294 RG 124.56 w 32.32001 655.12 m 564.96997 655.12 l S 1 1 1 RG 20.58 w 31.2 604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 982 0 obj 6356 endobj 983 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 0.75294 0.75294 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1004 0 obj 4650 endobj 1005 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 461.31998 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35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1008 0 obj 5469 endobj 1009 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1010 0 obj 8855 endobj 1011 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1012 0 obj 2934 endobj 1013 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1014 0 obj 3668 endobj 1015 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1016 0 obj 1865 endobj 1017 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1018 0 obj 6632 endobj 1019 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1020 0 obj 5629 endobj 1021 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1022 0 obj 1466 endobj 1023 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1024 0 obj 1804 endobj 1025 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1026 0 obj 6050 endobj 1027 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1028 0 obj 3970 endobj 1029 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1030 0 obj 5601 endobj 1031 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1032 0 obj 5363 endobj 1033 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1034 0 obj 5105 endobj 1035 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1036 0 obj 1350 endobj 1037 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1038 0 obj 5799 endobj 1039 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1040 0 obj 5325 endobj 1041 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1042 0 obj 4303 endobj 1043 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 1044 0 obj 5693 endobj 1045 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 1046 0 obj 1319 endobj 1047 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 1048 0 obj 5584 endobj 1049 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 1050 0 obj 5389 endobj 1051 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 1052 0 obj 2300 endobj 1053 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 1054 0 obj 5735 endobj 1055 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 1056 0 obj 5318 endobj 1057 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 1058 0 obj 5389 endobj 1059 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 1060 0 obj 2531 endobj 1061 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 1062 0 obj 5756 endobj 1063 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 1064 0 obj 5301 endobj 1065 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 1066 0 obj 5063 endobj 1067 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 1068 0 obj 3690 endobj 1069 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 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604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 1070 0 obj 6356 endobj 1071 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1092 0 obj 4650 endobj 1093 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 461.31998 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35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1096 0 obj 5469 endobj 1097 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1098 0 obj 8855 endobj 1099 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1100 0 obj 2934 endobj 1101 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1102 0 obj 3668 endobj 1103 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1104 0 obj 1865 endobj 1105 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1106 0 obj 6632 endobj 1107 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1108 0 obj 5629 endobj 1109 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1110 0 obj 1466 endobj 1111 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1112 0 obj 1804 endobj 1113 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1114 0 obj 6050 endobj 1115 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1116 0 obj 3970 endobj 1117 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1118 0 obj 5601 endobj 1119 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1120 0 obj 5363 endobj 1121 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1122 0 obj 5105 endobj 1123 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1124 0 obj 1350 endobj 1125 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1126 0 obj 5799 endobj 1127 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1128 0 obj 5325 endobj 1129 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1130 0 obj 4303 endobj 1131 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 1132 0 obj 5693 endobj 1133 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 1134 0 obj 1319 endobj 1135 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 1136 0 obj 5584 endobj 1137 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 1138 0 obj 5389 endobj 1139 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 1140 0 obj 2300 endobj 1141 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 1142 0 obj 5735 endobj 1143 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 1144 0 obj 5318 endobj 1145 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 1146 0 obj 5389 endobj 1147 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 1148 0 obj 2531 endobj 1149 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 1150 0 obj 5756 endobj 1151 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 1152 0 obj 5301 endobj 1153 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 1154 0 obj 5063 endobj 1155 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 1156 0 obj 3690 endobj 1157 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 494.10001 784.77997 l S 0.95294 0.95294 0.95294 RG 496.34998 784.77997 m 539.10004 784.77997 l S 1 1 1 RG 541.34998 784.77997 m 566.10004 784.77997 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 794.40002 m 568.29999 794.40002 l S 26.14 813.64996 m 568.29999 813.64996 l S 26.14 794.40002 m 568.29999 794.40002 l S 26.14 775.14996 m 568.29999 775.14996 l S 27.22 814.72998 m 27.22 774.07996 l S 423.22 795.47998 m 423.22 774.07996 l S 468.22 795.47998 m 468.22 774.07996 l S 495.22 795.47998 m 495.22 774.07996 l S 540.21997 795.47998 m 540.21997 774.07996 l S 567.21997 814.72998 m 567.21997 774.07996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 33.75 800.46997 Tm (Are there any outstanding requirements from the last inspection?)Tj 1 0 0 1 429.75 781.21997 Tm (Yes)Tj /C2_0 12 Tf 1 0 0 1 476.37 783.15997 Tm <0085>Tj /T1_0 12 Tf 1 0 0 1 501.75 781.21997 Tm (No)Tj /C2_0 12 Tf 1 0 0 1 548.37 783.15997 Tm <0035>Tj ET 0.95294 0.95294 0.95294 RG 124.56 w 32.32001 655.12 m 564.96997 655.12 l S 1 1 1 RG 20.58 w 31.2 604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 1158 0 obj 6356 endobj 1159 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1180 0 obj 4650 endobj 1181 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 461.31998 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35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1184 0 obj 5469 endobj 1185 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1186 0 obj 8855 endobj 1187 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1188 0 obj 2934 endobj 1189 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1190 0 obj 3668 endobj 1191 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1192 0 obj 1865 endobj 1193 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1194 0 obj 6632 endobj 1195 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1196 0 obj 5629 endobj 1197 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1198 0 obj 1466 endobj 1199 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1200 0 obj 1804 endobj 1201 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1202 0 obj 6050 endobj 1203 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1204 0 obj 3970 endobj 1205 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1206 0 obj 5601 endobj 1207 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1208 0 obj 5363 endobj 1209 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1210 0 obj 5105 endobj 1211 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1212 0 obj 1350 endobj 1213 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1214 0 obj 5799 endobj 1215 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1216 0 obj 5325 endobj 1217 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1218 0 obj 4303 endobj 1219 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 1220 0 obj 5693 endobj 1221 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 1222 0 obj 1319 endobj 1223 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 1224 0 obj 5584 endobj 1225 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 1226 0 obj 5389 endobj 1227 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 1228 0 obj 2300 endobj 1229 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 1230 0 obj 5735 endobj 1231 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 1232 0 obj 5318 endobj 1233 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 1234 0 obj 5389 endobj 1235 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 1236 0 obj 2531 endobj 1237 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 1238 0 obj 5756 endobj 1239 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 1240 0 obj 5301 endobj 1241 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 1242 0 obj 5063 endobj 1243 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 1244 0 obj 3690 endobj 1245 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 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604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 1246 0 obj 6356 endobj 1247 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1268 0 obj 38265 endobj 1269 0 obj<>stream HlVXTW{`=1v fubWtAQ`KD챏{q65X`rct;s;Pp+ϞN)K~1 8 MN}t@ [n`^NɠÀ/_6Y-VvpUmUrΐU'qMU~/bS ɯc|=68&2/GIy1v3Q;xj՘F1(eRN4hYxut\8|ygnU/,ԭ7UE7M%fp*WBEJTuVխFZԭN}dnM6kޢeyyom۵бS.]?ֽ߽}zw߾8h~8*аH11q c%OI01m)SM1s9̹8k/d+>]*go٦[mwwڽg:|ǎ8ygΞ;W"7oݾs/?fHT' &s p5t3x ) rɹrUk# m{SFzkQwս):}h0kMFƖQ&ar2U5U705z,p[<{\x\p8J9EwU,Hb1C'jԪhQZ{{RzW,*[`1%jEW,/Yp,s؀*E*)Ewn*)(X\X`FB}ABèւK+oP*Kt@TҜǺ}Ua*!&9kUud4,7yJl:(NB<ƿ>lRu<lYbB,nW2hSZ5\͸[ٜ۸]iΝý<P*[GaqJqXq\JsK~*\~%#jK.WyݦbS7Tip o*E)nW?lXTũs|JmY%vJ$TuC]4F*-NV}aWa]6@J zP~TڎUyP\5U!J2KPڞ4 |,zSQUGZ<\uprCEKJnU ,[8 UsZ[x"ֈ!ۭ!6hZr%&vm6[mU,^-Uh h\WnE$[kۼK&ث7 w˴hT?3羖 uɖ%nvM%KAIjQO"V >fc}l[GzYw1vcv S2}],Vu7q\N:N߶d²l,Lc qackjjH LҖФ1 Цa:0L̤3U ;2LOzｽ{{oۛ+3X\,",]ˢ]=p}7+Maꙩ(䲞Y p{3XlZSi aSX}4J%yDtc6:c=K:pܓVS,~q#N&Wn^)5Ap׃]fJ.BC ̧>B0V0$ *OWqg,~2s? 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100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1276 0 obj 5469 endobj 1277 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1278 0 obj 8855 endobj 1279 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 774.21997 m 267.94998 774.21997 l S 1 1 1 RG 270.20001 774.21997 m 565.64996 774.21997 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 716.22998 m 267.94998 716.22998 l S 1 1 1 RG 270.20001 716.22998 m 565.64996 716.22998 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 658.23999 m 267.94998 658.23999 l S 1 1 1 RG 270.20001 658.23999 m 565.64996 658.23999 l S 0.95294 0.95294 0.95294 RG 31.2 635.40997 m 267.94998 635.40997 l S 1 1 1 RG 270.20001 635.40997 m 565.64996 635.40997 l S 0.95294 0.95294 0.95294 RG 31.2 612.57996 m 267.94998 612.57996 l S 1 1 1 RG 270.20001 612.57996 m 565.64996 612.57996 l S 0.95294 0.95294 0.95294 RG 31.2 589.75 m 267.94998 589.75 l S 1 1 1 RG 270.20001 589.75 m 565.64996 589.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 762.79999 m 567.84998 762.79999 l S 28.99001 669.64996 m 567.84998 669.64996 l S 28.99001 646.82001 m 567.84998 646.82001 l S 28.99001 623.98999 m 567.84998 623.98999 l S 28.99001 601.15997 m 567.84998 601.15997 l S 28.99001 785.63 m 567.84998 785.63 l S 28.99001 762.79999 m 567.84998 762.79999 l S 28.99001 669.64996 m 567.84998 669.64996 l S 28.99001 646.82001 m 567.84998 646.82001 l S 28.99001 623.98999 m 567.84998 623.98999 l S 28.99001 601.15997 m 567.84998 601.15997 l S 28.99001 578.33002 m 567.84998 578.33002 l S 30.07001 786.70996 m 30.07001 577.26001 l S 269.07001 786.70996 m 269.07001 577.26001 l S 566.76996 786.70996 m 566.76996 577.26001 l S BT /T1_0 12 Tf 1 0 0 1 34.05 769.45001 Tm (Name of care home:)Tj 1 0 0 1 273.04999 769.45001 Tm (The Manor House)Tj 1 0 0 1 34.05 746.62 Tm (Address:)Tj 1 0 0 1 273.04999 746.62 Tm (135 Loosleigh Lane)Tj 1 0 0 1 273.04999 729.03998 Tm (Derriford)Tj 1 0 0 1 273.04999 711.45996 Tm (Plymouth)Tj 1 0 0 1 273.04999 693.88 Tm (Devon)Tj 1 0 0 1 273.04999 676.29999 Tm (PL6 5JE)Tj 1 0 0 1 34.05 653.46997 Tm (Telephone number:)Tj 1 0 0 1 273.04999 653.46997 Tm (01752777572)Tj 1 0 0 1 34.05 630.64001 Tm (Fax number:)Tj 1 0 0 1 273.04999 630.64001 Tm (01572776628)Tj 1 0 0 1 34.05 607.81 Tm (Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 541.76996 Tm (Name of registered provider\(s\):)Tj 1 0 0 1 355.5 541.76996 Tm (South West Care Homes Limited)Tj 1 0 0 1 34.05 518.94 Tm (Type of registration:)Tj 1 0 0 1 358.35001 518.94 Tm (care home)Tj 1 0 0 1 34.05 496.10999 Tm (Number of places registered:)Tj 1 0 0 1 358.35001 496.10999 Tm (30)Tj /T1_0 10 Tf 1 0 0 1 28.35001 477.16998 Tm (\240)Tj 1 0 0 1 28.35001 460.16998 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 63.99001 w 32.32001 417.84998 m 564.46997 417.84998 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 429.25998 m 567.79999 429.25998 l S 28.99001 452.09 m 567.79999 452.09 l S 28.99001 429.25998 m 567.79999 429.25998 l S 28.99001 385.85001 m 567.79999 385.85001 l S 30.07001 453.16998 m 30.07001 384.76999 l S 298.32001 430.34 m 298.32001 384.76999 l S 566.71997 453.16998 m 566.71997 384.76999 l S BT /T1_0 12 Tf 1 0 0 1 34.05 435.91 Tm (Conditions of registration:)Tj 1 0 0 1 34.05 413.07999 Tm (Category\(ies\) :)Tj 1 0 0 1 302.30002 413.07999 Tm (Number of places \(if applicable\):)Tj 1 0 0 1 302.30002 392.5 Tm (Under 65)Tj 1 0 0 1 435.37 392.5 Tm (Over 65)Tj ET 1 1 1 RG 20.58 w 31.2 371.06 m 297.30002 371.06 l S 299.54999 371.06 m 431.44998 371.06 l S 433.70001 371.06 m 565.60004 371.06 l S 35.16 w 31.2 340.94 m 297.30002 340.94 l S 299.54999 340.94 m 431.44998 340.94 l S 433.70001 340.94 m 565.60004 340.94 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 310.82001 m 565.60004 310.82001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 567.79999 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 382.47998 m 567.79999 382.47998 l S 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 568.10004 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 210.00998 m 568.10004 210.00998 l S 30.07001 383.54999 m 30.07001 208.92998 l S 298.41998 383.54999 m 298.41998 321.16 l S 432.56998 383.54999 m 432.56998 321.16 l S 566.71997 383.54999 m 566.71997 208.92998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 366.28998 Tm (dementia)Tj 1 0 0 1 302.39999 366.28998 Tm (30)Tj 1 0 0 1 436.54999 366.28998 Tm (0)Tj 1 0 0 1 34.05 343.45999 Tm (old age, not falling within any other )Tj 1 0 0 1 34.05 328.88 Tm (category)Tj 1 0 0 1 302.39999 343.45999 Tm (0)Tj 1 0 0 1 436.54999 343.45999 Tm (30)Tj 1 0 0 1 34.05 306.04999 Tm (Additional conditions: )Tj 1 0 0 1 34.05 283.22 Tm (The maximum number of service users who can be accommodated is 30)Tj 1 0 0 1 34.05 260.38998 Tm (The registered person may provide the following category of service only\ : Care Home )Tj 1 0 0 1 34.05 245.81 Tm (only - Code PC to service users of either gender whose primary care need\ s are within )Tj 1 0 0 1 34.05 231.23 Tm (the following categories: Old age, not falling within any other catetgor\ y \(Code OP\) )Tj 1 0 0 1 34.05 216.64998 Tm (Dementia \(Code DE\))Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 195.22 m 315.25 195.22 l S 1 1 1 RG 317.5 195.22 m 346.54999 195.22 l S 348.80002 195.22 m 377.89999 195.22 l S 380.14999 195.22 m 409.20001 195.22 l S 411.44998 195.22 m 440.54999 195.22 l S 442.80002 195.22 m 471.89993 195.22 l S 474.14993 195.22 m 503.20001 195.22 l S 505.44998 195.22 m 534.54999 195.22 l S 536.79999 195.22 m 565.90002 195.22 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 206.62999 m 568.10004 206.62999 l S 28.99001 183.8 m 568.10004 183.8 l S 30.07001 207.70999 m 30.07001 182.73 l S 316.37 207.70999 m 316.37 182.73 l S 347.66998 207.70999 m 347.66998 182.73 l S 379.01999 207.70999 m 379.01999 182.73 l S 410.31998 207.70999 m 410.31998 182.73 l S 441.66998 207.70999 m 441.66998 182.73 l S 473.01999 207.70999 m 473.01999 182.73 l S 504.31998 207.70999 m 504.31998 182.73 l S 535.66998 207.70999 m 535.66998 182.73 l S 567.01996 207.70999 m 567.01996 182.73 l S BT /T1_0 12 Tf 1 0 0 1 34.05 190.45 Tm (Date of last inspection)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 171.92999 m 565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1280 0 obj 2934 endobj 1281 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1282 0 obj 3668 endobj 1283 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1284 0 obj 1865 endobj 1285 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1286 0 obj 6632 endobj 1287 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1288 0 obj 5629 endobj 1289 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1290 0 obj 1466 endobj 1291 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1292 0 obj 1804 endobj 1293 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1294 0 obj 6050 endobj 1295 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1296 0 obj 3970 endobj 1297 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1298 0 obj 5601 endobj 1299 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1300 0 obj 5363 endobj 1301 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1302 0 obj 5105 endobj 1303 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1304 0 obj 1350 endobj 1305 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1306 0 obj 5799 endobj 1307 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1308 0 obj 5325 endobj 1309 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1310 0 obj 4303 endobj 1311 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 1312 0 obj 5693 endobj 1313 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 1314 0 obj 1319 endobj 1315 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 1316 0 obj 5584 endobj 1317 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 1318 0 obj 5389 endobj 1319 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 1320 0 obj 2300 endobj 1321 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 1322 0 obj 5735 endobj 1323 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 1324 0 obj 5318 endobj 1325 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 1326 0 obj 5389 endobj 1327 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 1328 0 obj 2531 endobj 1329 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 1330 0 obj 5756 endobj 1331 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 1332 0 obj 5301 endobj 1333 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 1334 0 obj 5063 endobj 1335 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 1336 0 obj 3690 endobj 1337 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 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567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 1338 0 obj 6356 endobj 1339 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 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within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 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requirements set out what the registered person must do to meet th\ e Care )Tj 1 0 0 1 34.05 581.70001 Tm (Standards Act 2000, Care Homes)Tj 1 0 0 1 239.76999 581.70001 Tm (Regulations 2001 and the National Minimum )Tj 1 0 0 1 34.05 567.12 Tm (Standards. 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We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1431 0 obj 5469 endobj 1432 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1433 0 obj 8855 endobj 1434 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1435 0 obj 2934 endobj 1436 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1437 0 obj 3668 endobj 1438 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1439 0 obj 1865 endobj 1440 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1441 0 obj 6632 endobj 1442 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1443 0 obj 5629 endobj 1444 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1445 0 obj 1466 endobj 1446 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1447 0 obj 1804 endobj 1448 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1449 0 obj 6050 endobj 1450 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1451 0 obj 3970 endobj 1452 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1453 0 obj 5601 endobj 1454 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1455 0 obj 5363 endobj 1456 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1457 0 obj 5105 endobj 1458 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1459 0 obj 1350 endobj 1460 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1461 0 obj 5799 endobj 1462 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1463 0 obj 5325 endobj 1464 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1465 0 obj 4303 endobj 1466 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 1467 0 obj 5693 endobj 1468 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 1469 0 obj 1319 endobj 1470 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 1471 0 obj 5584 endobj 1472 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 1473 0 obj 5389 endobj 1474 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 1475 0 obj 2300 endobj 1476 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 1477 0 obj 5735 endobj 1478 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 1479 0 obj 5318 endobj 1480 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 1481 0 obj 5389 endobj 1482 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 1483 0 obj 2531 endobj 1484 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 1485 0 obj 5756 endobj 1486 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 1487 0 obj 5301 endobj 1488 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 1489 0 obj 5063 endobj 1490 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 1491 0 obj 3690 endobj 1492 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 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It is also recommended to have a )Tj 1 0 0 1 202.5 306.25998 Tm (sample list of staff signatures, to be able to identify staff )Tj 1 0 0 1 202.5 291.67999 Tm (who have given medicines to people.)Tj 1 0 0 1 202.5 277.10001 Tm (These are to reduce the risk of any medicines errors )Tj 1 0 0 1 202.5 262.51999 Tm (occurring.)Tj 1 0 0 1 34.05 239.68999 Tm (2)Tj 1 0 0 1 96.15001 239.68999 Tm (16)Tj 1 0 0 1 202.5 239.68999 Tm (The complaints procedure should be displayed in a )Tj 1 0 0 1 202.5 225.11 Tm (prominent position and at a height that is easily readable )Tj 1 0 0 1 202.5 210.53 Tm (by everyone.)Tj 1 0 0 1 34.05 187.7 Tm (3)Tj 1 0 0 1 96.15001 187.7 Tm (33)Tj 1 0 0 1 202.5 187.7 Tm (An effective quality assurance system, with a summary of )Tj 1 0 0 1 202.5 173.12 Tm (any findings,should be put in place that actively involves )Tj 1 0 0 1 202.5 158.53999 Tm (and seeks the views of the people using this service, their )Tj 1 0 0 1 202.5 143.95999 Tm (friends and family, and stakeholders who have contacts )Tj 1 0 0 1 202.5 129.37999 Tm (with the home.)Tj 1 0 0 1 34.05 106.55 Tm (4)Tj 1 0 0 1 96.15001 106.55 Tm (38)Tj 1 0 0 1 202.5 106.55 Tm (A full review of the physical environment should be )Tj 1 0 0 1 202.5 91.97 Tm (undertaken to ensure that signage is in place or replaced )Tj 1 0 0 1 202.5 77.39 Tm (where it is worn or missing. 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1515 0 obj 4650 endobj 1516 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 461.31998 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35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1519 0 obj 5469 endobj 1520 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1521 0 obj 8855 endobj 1522 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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applicable\):)Tj 1 0 0 1 302.30002 392.5 Tm (Under 65)Tj 1 0 0 1 435.37 392.5 Tm (Over 65)Tj ET 1 1 1 RG 20.58 w 31.2 371.06 m 297.30002 371.06 l S 299.54999 371.06 m 431.44998 371.06 l S 433.70001 371.06 m 565.60004 371.06 l S 35.16 w 31.2 340.94 m 297.30002 340.94 l S 299.54999 340.94 m 431.44998 340.94 l S 433.70001 340.94 m 565.60004 340.94 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 310.82001 m 565.60004 310.82001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 567.79999 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 382.47998 m 567.79999 382.47998 l S 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 568.10004 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 210.00998 m 568.10004 210.00998 l S 30.07001 383.54999 m 30.07001 208.92998 l S 298.41998 383.54999 m 298.41998 321.16 l S 432.56998 383.54999 m 432.56998 321.16 l S 566.71997 383.54999 m 566.71997 208.92998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 366.28998 Tm (dementia)Tj 1 0 0 1 302.39999 366.28998 Tm (30)Tj 1 0 0 1 436.54999 366.28998 Tm (0)Tj 1 0 0 1 34.05 343.45999 Tm (old age, not falling within any other )Tj 1 0 0 1 34.05 328.88 Tm (category)Tj 1 0 0 1 302.39999 343.45999 Tm (0)Tj 1 0 0 1 436.54999 343.45999 Tm (30)Tj 1 0 0 1 34.05 306.04999 Tm (Additional conditions: )Tj 1 0 0 1 34.05 283.22 Tm (The maximum number of service users who can be accommodated is 30)Tj 1 0 0 1 34.05 260.38998 Tm (The registered person may provide the following category of service only\ : Care Home )Tj 1 0 0 1 34.05 245.81 Tm (only - Code PC to service users of either gender whose primary care need\ s are within )Tj 1 0 0 1 34.05 231.23 Tm (the following categories: Old age, not falling within any other catetgor\ y \(Code OP\) )Tj 1 0 0 1 34.05 216.64998 Tm (Dementia \(Code DE\))Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 195.22 m 315.25 195.22 l S 1 1 1 RG 317.5 195.22 m 346.54999 195.22 l S 348.80002 195.22 m 377.89999 195.22 l S 380.14999 195.22 m 409.20001 195.22 l S 411.44998 195.22 m 440.54999 195.22 l S 442.80002 195.22 m 471.89993 195.22 l S 474.14993 195.22 m 503.20001 195.22 l S 505.44998 195.22 m 534.54999 195.22 l S 536.79999 195.22 m 565.90002 195.22 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 206.62999 m 568.10004 206.62999 l S 28.99001 183.8 m 568.10004 183.8 l S 30.07001 207.70999 m 30.07001 182.73 l S 316.37 207.70999 m 316.37 182.73 l S 347.66998 207.70999 m 347.66998 182.73 l S 379.01999 207.70999 m 379.01999 182.73 l S 410.31998 207.70999 m 410.31998 182.73 l S 441.66998 207.70999 m 441.66998 182.73 l S 473.01999 207.70999 m 473.01999 182.73 l S 504.31998 207.70999 m 504.31998 182.73 l S 535.66998 207.70999 m 535.66998 182.73 l S 567.01996 207.70999 m 567.01996 182.73 l S BT /T1_0 12 Tf 1 0 0 1 34.05 190.45 Tm (Date of last inspection)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 171.92999 m 565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1523 0 obj 2934 endobj 1524 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1525 0 obj 3668 endobj 1526 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1527 0 obj 1865 endobj 1528 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1529 0 obj 6632 endobj 1530 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1531 0 obj 5629 endobj 1532 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1533 0 obj 1466 endobj 1534 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1535 0 obj 1804 endobj 1536 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1537 0 obj 6050 endobj 1538 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1539 0 obj 3970 endobj 1540 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1541 0 obj 5601 endobj 1542 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1543 0 obj 5363 endobj 1544 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1545 0 obj 5105 endobj 1546 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1547 0 obj 1350 endobj 1548 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1549 0 obj 5799 endobj 1550 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1551 0 obj 5325 endobj 1552 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1553 0 obj 4303 endobj 1554 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 1555 0 obj 5693 endobj 1556 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 1557 0 obj 1319 endobj 1558 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 1559 0 obj 5584 endobj 1560 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 1561 0 obj 5389 endobj 1562 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 1563 0 obj 2300 endobj 1564 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 1565 0 obj 5735 endobj 1566 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 1567 0 obj 5318 endobj 1568 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 1569 0 obj 5389 endobj 1570 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 1571 0 obj 2531 endobj 1572 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 1573 0 obj 5756 endobj 1574 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 1575 0 obj 5301 endobj 1576 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 1577 0 obj 5063 endobj 1578 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 1579 0 obj 3690 endobj 1580 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 494.10001 784.77997 l S 0.95294 0.95294 0.95294 RG 496.34998 784.77997 m 539.10004 784.77997 l S 1 1 1 RG 541.34998 784.77997 m 566.10004 784.77997 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 794.40002 m 568.29999 794.40002 l S 26.14 813.64996 m 568.29999 813.64996 l S 26.14 794.40002 m 568.29999 794.40002 l S 26.14 775.14996 m 568.29999 775.14996 l S 27.22 814.72998 m 27.22 774.07996 l S 423.22 795.47998 m 423.22 774.07996 l S 468.22 795.47998 m 468.22 774.07996 l S 495.22 795.47998 m 495.22 774.07996 l S 540.21997 795.47998 m 540.21997 774.07996 l S 567.21997 814.72998 m 567.21997 774.07996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 33.75 800.46997 Tm (Are there any outstanding requirements from the last inspection?)Tj 1 0 0 1 429.75 781.21997 Tm (Yes)Tj /C2_0 12 Tf 1 0 0 1 476.37 783.15997 Tm <0085>Tj /T1_0 12 Tf 1 0 0 1 501.75 781.21997 Tm (No)Tj /C2_0 12 Tf 1 0 0 1 548.37 783.15997 Tm <0035>Tj ET 0.95294 0.95294 0.95294 RG 124.56 w 32.32001 655.12 m 564.96997 655.12 l S 1 1 1 RG 20.58 w 31.2 604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 1581 0 obj 6356 endobj 1582 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 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It is also recommended to have a )Tj 1 0 0 1 202.5 306.25998 Tm (sample list of staff signatures, to be able to identify staff )Tj 1 0 0 1 202.5 291.67999 Tm (who have given medicines to people.)Tj 1 0 0 1 202.5 277.10001 Tm (These are to reduce the risk of any medicines errors )Tj 1 0 0 1 202.5 262.51999 Tm (occurring.)Tj 1 0 0 1 34.05 239.68999 Tm (2)Tj 1 0 0 1 96.15001 239.68999 Tm (16)Tj 1 0 0 1 202.5 239.68999 Tm (The complaints procedure should be displayed in a )Tj 1 0 0 1 202.5 225.11 Tm (prominent position and at a height that is easily readable )Tj 1 0 0 1 202.5 210.53 Tm (by everyone.)Tj 1 0 0 1 34.05 187.7 Tm (3)Tj 1 0 0 1 96.15001 187.7 Tm (33)Tj 1 0 0 1 202.5 187.7 Tm (An effective quality assurance system, with a summary of )Tj 1 0 0 1 202.5 173.12 Tm (any findings,should be put in place that actively involves )Tj 1 0 0 1 202.5 158.53999 Tm (and seeks the views of the people using this service, their )Tj 1 0 0 1 202.5 143.95999 Tm (friends and family, and stakeholders who have contacts )Tj 1 0 0 1 202.5 129.37999 Tm (with the home.)Tj 1 0 0 1 34.05 106.55 Tm (4)Tj 1 0 0 1 96.15001 106.55 Tm (38)Tj 1 0 0 1 202.5 106.55 Tm (A full review of the physical environment should be )Tj 1 0 0 1 202.5 91.97 Tm (undertaken to ensure that signage is in place or replaced )Tj 1 0 0 1 202.5 77.39 Tm (where it is worn or missing. 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1603 0 obj 4650 endobj 1604 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 461.31998 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35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1607 0 obj 5469 endobj 1608 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1609 0 obj 8855 endobj 1610 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1611 0 obj 2934 endobj 1612 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1613 0 obj 3668 endobj 1614 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1615 0 obj 1865 endobj 1616 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1617 0 obj 6632 endobj 1618 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1619 0 obj 5629 endobj 1620 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1621 0 obj 1466 endobj 1622 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1623 0 obj 1804 endobj 1624 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1625 0 obj 6050 endobj 1626 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1627 0 obj 3970 endobj 1628 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1629 0 obj 5601 endobj 1630 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1631 0 obj 5363 endobj 1632 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1633 0 obj 5105 endobj 1634 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1635 0 obj 1350 endobj 1636 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1637 0 obj 5799 endobj 1638 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1639 0 obj 5325 endobj 1640 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1641 0 obj 4303 endobj 1642 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 1643 0 obj 5693 endobj 1644 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 1645 0 obj 1319 endobj 1646 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 1647 0 obj 5584 endobj 1648 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 1649 0 obj 5389 endobj 1650 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 1651 0 obj 2300 endobj 1652 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 1653 0 obj 5735 endobj 1654 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 1655 0 obj 5318 endobj 1656 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 1657 0 obj 5389 endobj 1658 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 1659 0 obj 2531 endobj 1660 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 1661 0 obj 5756 endobj 1662 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 1663 0 obj 5301 endobj 1664 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 1665 0 obj 5063 endobj 1666 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 1667 0 obj 3690 endobj 1668 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 494.10001 784.77997 l S 0.95294 0.95294 0.95294 RG 496.34998 784.77997 m 539.10004 784.77997 l S 1 1 1 RG 541.34998 784.77997 m 566.10004 784.77997 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 794.40002 m 568.29999 794.40002 l S 26.14 813.64996 m 568.29999 813.64996 l S 26.14 794.40002 m 568.29999 794.40002 l S 26.14 775.14996 m 568.29999 775.14996 l S 27.22 814.72998 m 27.22 774.07996 l S 423.22 795.47998 m 423.22 774.07996 l S 468.22 795.47998 m 468.22 774.07996 l S 495.22 795.47998 m 495.22 774.07996 l S 540.21997 795.47998 m 540.21997 774.07996 l S 567.21997 814.72998 m 567.21997 774.07996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 33.75 800.46997 Tm (Are there any outstanding requirements from the last inspection?)Tj 1 0 0 1 429.75 781.21997 Tm (Yes)Tj /C2_0 12 Tf 1 0 0 1 476.37 783.15997 Tm <0085>Tj /T1_0 12 Tf 1 0 0 1 501.75 781.21997 Tm (No)Tj /C2_0 12 Tf 1 0 0 1 548.37 783.15997 Tm <0035>Tj ET 0.95294 0.95294 0.95294 RG 124.56 w 32.32001 655.12 m 564.96997 655.12 l S 1 1 1 RG 20.58 w 31.2 604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 1669 0 obj 6356 endobj 1670 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1691 0 obj 4650 endobj 1692 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 461.31998 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35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1695 0 obj 5469 endobj 1696 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1697 0 obj 8855 endobj 1698 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1699 0 obj 2934 endobj 1700 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1701 0 obj 3668 endobj 1702 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1703 0 obj 1865 endobj 1704 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1705 0 obj 6632 endobj 1706 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1707 0 obj 5629 endobj 1708 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1709 0 obj 1466 endobj 1710 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1711 0 obj 1804 endobj 1712 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1713 0 obj 6050 endobj 1714 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1715 0 obj 3970 endobj 1716 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1717 0 obj 5601 endobj 1718 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1719 0 obj 5363 endobj 1720 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1721 0 obj 5105 endobj 1722 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1723 0 obj 1350 endobj 1724 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1725 0 obj 5799 endobj 1726 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1727 0 obj 5325 endobj 1728 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1729 0 obj 4303 endobj 1730 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 1731 0 obj 5693 endobj 1732 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 1733 0 obj 1319 endobj 1734 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 1735 0 obj 5584 endobj 1736 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 1737 0 obj 5389 endobj 1738 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 1739 0 obj 2300 endobj 1740 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 1741 0 obj 5735 endobj 1742 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 1743 0 obj 5318 endobj 1744 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 1745 0 obj 5389 endobj 1746 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 1747 0 obj 2531 endobj 1748 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 1749 0 obj 5756 endobj 1750 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 1751 0 obj 5301 endobj 1752 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 1753 0 obj 5063 endobj 1754 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 1755 0 obj 3690 endobj 1756 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 494.10001 784.77997 l S 0.95294 0.95294 0.95294 RG 496.34998 784.77997 m 539.10004 784.77997 l S 1 1 1 RG 541.34998 784.77997 m 566.10004 784.77997 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 794.40002 m 568.29999 794.40002 l S 26.14 813.64996 m 568.29999 813.64996 l S 26.14 794.40002 m 568.29999 794.40002 l S 26.14 775.14996 m 568.29999 775.14996 l S 27.22 814.72998 m 27.22 774.07996 l S 423.22 795.47998 m 423.22 774.07996 l S 468.22 795.47998 m 468.22 774.07996 l S 495.22 795.47998 m 495.22 774.07996 l S 540.21997 795.47998 m 540.21997 774.07996 l S 567.21997 814.72998 m 567.21997 774.07996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 33.75 800.46997 Tm (Are there any outstanding requirements from the last inspection?)Tj 1 0 0 1 429.75 781.21997 Tm (Yes)Tj /C2_0 12 Tf 1 0 0 1 476.37 783.15997 Tm <0085>Tj /T1_0 12 Tf 1 0 0 1 501.75 781.21997 Tm (No)Tj /C2_0 12 Tf 1 0 0 1 548.37 783.15997 Tm <0035>Tj ET 0.95294 0.95294 0.95294 RG 124.56 w 32.32001 655.12 m 564.96997 655.12 l S 1 1 1 RG 20.58 w 31.2 604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 1757 0 obj 6356 endobj 1758 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1779 0 obj 4650 endobj 1780 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 461.31998 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35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1783 0 obj 5469 endobj 1784 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1785 0 obj 8855 endobj 1786 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1787 0 obj 2934 endobj 1788 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1789 0 obj 3668 endobj 1790 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1791 0 obj 1865 endobj 1792 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1793 0 obj 6632 endobj 1794 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1795 0 obj 5629 endobj 1796 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1797 0 obj 1466 endobj 1798 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1799 0 obj 1804 endobj 1800 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1801 0 obj 6050 endobj 1802 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1803 0 obj 3970 endobj 1804 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1805 0 obj 5601 endobj 1806 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1807 0 obj 5363 endobj 1808 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1809 0 obj 5105 endobj 1810 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1811 0 obj 1350 endobj 1812 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1813 0 obj 5799 endobj 1814 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1815 0 obj 5325 endobj 1816 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1817 0 obj 4303 endobj 1818 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 1819 0 obj 5693 endobj 1820 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 1821 0 obj 1319 endobj 1822 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 1823 0 obj 5584 endobj 1824 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 1825 0 obj 5389 endobj 1826 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 1827 0 obj 2300 endobj 1828 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 1829 0 obj 5735 endobj 1830 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 1831 0 obj 5318 endobj 1832 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 1833 0 obj 5389 endobj 1834 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 1835 0 obj 2531 endobj 1836 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 1837 0 obj 5756 endobj 1838 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 1839 0 obj 5301 endobj 1840 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 1841 0 obj 5063 endobj 1842 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 1843 0 obj 3690 endobj 1844 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 494.10001 784.77997 l S 0.95294 0.95294 0.95294 RG 496.34998 784.77997 m 539.10004 784.77997 l S 1 1 1 RG 541.34998 784.77997 m 566.10004 784.77997 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 794.40002 m 568.29999 794.40002 l S 26.14 813.64996 m 568.29999 813.64996 l S 26.14 794.40002 m 568.29999 794.40002 l S 26.14 775.14996 m 568.29999 775.14996 l S 27.22 814.72998 m 27.22 774.07996 l S 423.22 795.47998 m 423.22 774.07996 l S 468.22 795.47998 m 468.22 774.07996 l S 495.22 795.47998 m 495.22 774.07996 l S 540.21997 795.47998 m 540.21997 774.07996 l S 567.21997 814.72998 m 567.21997 774.07996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 33.75 800.46997 Tm (Are there any outstanding requirements from the last inspection?)Tj 1 0 0 1 429.75 781.21997 Tm (Yes)Tj /C2_0 12 Tf 1 0 0 1 476.37 783.15997 Tm <0085>Tj /T1_0 12 Tf 1 0 0 1 501.75 781.21997 Tm (No)Tj /C2_0 12 Tf 1 0 0 1 548.37 783.15997 Tm <0035>Tj ET 0.95294 0.95294 0.95294 RG 124.56 w 32.32001 655.12 m 564.96997 655.12 l S 1 1 1 RG 20.58 w 31.2 604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 1845 0 obj 6356 endobj 1846 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1867 0 obj 4650 endobj 1868 0 obj<>stream q 538.5 0 0 61.5 28.35001 14.2 cm /Im0 Do Q 0.75294 0.75294 0.75294 RG 1 i 94.5 w 10 M 0 j 0 J []0 d 22.95 766.40002 m 561.52997 766.40002 l S q 170.25 0 0 54.75 28.35001 750.90002 cm /Im1 Do Q 0 0 0 rg BT /C2_0 28 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 1 0 0 1 147.05 643.14001 Tm <002E0048005C0003004C005100560053004800460057004C005200510003005500480053005200550057>Tj ET 20.58 w 27.33 599.07001 m 557.14996 599.07001 l S 0 0 0 RG 0.5 w BT /T1_0 24 Tf 2 Tr 1 0 0 1 28.35001 551.37 Tm (Care homes for older people)Tj /C2_0 6 Tf 0 Tr 1 0 0 1 28.35001 540.33002 Tm <0003>Tj 1 0 0 1 28.35001 533.08997 Tm <0003>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 519.31 m 160.37999 519.31 l S 1 1 1 RG 162.62999 519.31 m 563.64996 519.31 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 461.31998 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35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1871 0 obj 5469 endobj 1872 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1873 0 obj 8855 endobj 1874 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 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(Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 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565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1875 0 obj 2934 endobj 1876 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1877 0 obj 3668 endobj 1878 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1879 0 obj 1865 endobj 1880 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1881 0 obj 6632 endobj 1882 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1883 0 obj 5629 endobj 1884 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1885 0 obj 1466 endobj 1886 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1887 0 obj 1804 endobj 1888 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1889 0 obj 6050 endobj 1890 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1891 0 obj 3970 endobj 1892 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1893 0 obj 5601 endobj 1894 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1895 0 obj 5363 endobj 1896 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1897 0 obj 5105 endobj 1898 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1899 0 obj 1350 endobj 1900 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1901 0 obj 5799 endobj 1902 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1903 0 obj 5325 endobj 1904 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1905 0 obj 4303 endobj 1906 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 1907 0 obj 5693 endobj 1908 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 1909 0 obj 1319 endobj 1910 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 1911 0 obj 5584 endobj 1912 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 1913 0 obj 5389 endobj 1914 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 1915 0 obj 2300 endobj 1916 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 1917 0 obj 5735 endobj 1918 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 1919 0 obj 5318 endobj 1920 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 1921 0 obj 5389 endobj 1922 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 1923 0 obj 2531 endobj 1924 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 1925 0 obj 5756 endobj 1926 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 1927 0 obj 5301 endobj 1928 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 1929 0 obj 5063 endobj 1930 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 1931 0 obj 3690 endobj 1932 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 494.10001 784.77997 l S 0.95294 0.95294 0.95294 RG 496.34998 784.77997 m 539.10004 784.77997 l S 1 1 1 RG 541.34998 784.77997 m 566.10004 784.77997 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 794.40002 m 568.29999 794.40002 l S 26.14 813.64996 m 568.29999 813.64996 l S 26.14 794.40002 m 568.29999 794.40002 l S 26.14 775.14996 m 568.29999 775.14996 l S 27.22 814.72998 m 27.22 774.07996 l S 423.22 795.47998 m 423.22 774.07996 l S 468.22 795.47998 m 468.22 774.07996 l S 495.22 795.47998 m 495.22 774.07996 l S 540.21997 795.47998 m 540.21997 774.07996 l S 567.21997 814.72998 m 567.21997 774.07996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 33.75 800.46997 Tm (Are there any outstanding requirements from the last inspection?)Tj 1 0 0 1 429.75 781.21997 Tm (Yes)Tj /C2_0 12 Tf 1 0 0 1 476.37 783.15997 Tm <0085>Tj /T1_0 12 Tf 1 0 0 1 501.75 781.21997 Tm (No)Tj /C2_0 12 Tf 1 0 0 1 548.37 783.15997 Tm <0035>Tj ET 0.95294 0.95294 0.95294 RG 124.56 w 32.32001 655.12 m 564.96997 655.12 l S 1 1 1 RG 20.58 w 31.2 604.26001 m 91.05 604.26001 l S 93.3 604.26001 m 197.40001 604.26001 l S 199.64998 604.26001 m 289.44998 604.26001 l S 291.70001 604.26001 m 473.80002 604.26001 l S 476.04999 604.26001 m 566.10004 604.26001 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 616.75 m 30.07001 591.76996 l S 567.21997 616.75 m 567.21997 591.76996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.29999 615.66998 l S 92.17 616.75 m 92.17 591.76996 l S 198.51999 616.75 m 198.51999 591.76996 l S 290.57001 616.75 m 290.57001 591.76996 l S 474.91998 616.75 m 474.91998 591.76996 l S 28.99001 719.64996 m 568.40002 719.64996 l S 28.99001 648.21997 m 568.40002 648.21997 l S 28.99001 615.66998 m 568.40002 615.66998 l S 28.99001 592.83997 m 568.29999 592.83997 l S 30.07001 720.72998 m 30.07001 614.60004 l S 92.12 649.29999 m 92.12 614.60004 l S 198.51999 649.29999 m 198.51999 614.60004 l S 290.62 649.29999 m 290.62 614.60004 l S 475.01999 649.29999 m 475.01999 614.60004 l S 567.32001 720.72998 m 567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 1933 0 obj 6356 endobj 1934 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 236.67998 m 568.29999 236.67998 l S 30.07001 529.01001 m 30.07001 60.7 l S 567.21997 529.01001 m 567.21997 60.7 l S 28.99001 560.47998 m 568.40002 560.47998 l S 28.99001 527.92999 m 568.29999 527.92999 l S 92.17 529.01001 m 92.17 60.7 l S 198.51999 529.01001 m 198.51999 60.7 l S 290.57001 529.01001 m 290.57001 60.7 l S 474.91998 529.01001 m 474.91998 60.7 l S 28.99001 629.46997 m 568.40002 629.46997 l S 28.99001 560.47998 m 568.40002 560.47998 l S 28.99001 527.92999 m 568.40002 527.92999 l S 28.99001 236.67998 m 568.29999 236.67998 l S 28.99001 61.78 m 568.29999 61.78 l S 30.07001 630.54999 m 30.07001 526.84998 l S 92.12 561.56 m 92.12 526.84998 l S 198.51999 561.56 m 198.51999 526.84998 l S 290.62 561.56 m 290.62 526.84998 l S 475.01999 561.56 m 475.01999 526.84998 l S 567.32001 630.54999 m 567.32001 526.84998 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 31.2 616.27997 Tm (Statutory requirements)Tj 0 Tr 1 0 0 1 34.05 596.27997 Tm (These 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If you would like \ a summary in a )Tj 1 0 0 1 28.35001 662.12 Tm (different format or language please contact our helpline or go to our we\ bsite.)Tj 1 0 0 1 28.35001 622.62 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). This publicatio\ n may be )Tj 1 0 0 1 28.35001 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium \ provided that it )Tj 1 0 0 1 28.35001 587.63 Tm (is not used for commercial gain. This consent is subject to the material\ being )Tj 1 0 0 1 28.35001 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory\ manner or )Tj 1 0 0 1 28.35001 552.64001 Tm (misleading context. The material should be acknowledged as CQC copyright\ , with the )Tj 1 0 0 1 28.35001 535.14001 Tm (title and date of publication of the document specified.)Tj ET endstream endobj 1957 0 obj 38265 endobj 1958 0 obj<>stream HlVXTW{`=1v fubWtAQ`KD챏{q65X`rct;s;Pp+ϞN)K~1 8 MN}t@ [n`^NɠÀ/_6Y-VvpUmUrΐU'qMU~/bS ɯc|=68&2/GIy1v3Q;xj՘F1(eRN4hYxut\8|ygnU/,ԭ7UE7M%fp*WBEJTuVխFZԭN}dnM6kޢeyyom۵бS.]?ֽ߽}zw߾8h~8*аH11q c%OI01m)SM1s9̹8k/d+>]*go٦[mwwڽg:|ǎ8ygΞ;W"7oݾs/?fHT' &s p5t3x ) rɹrUk# m{SFzkQwս):}h0kMFƖQ&ar2U5U705z,p[<{\x\p8J9EwU,Hb1C'jԪhQZ{{RzW,*[`1%jEW,/Yp,s؀*E*)Ewn*)(X\X`FB}ABèւK+oP*Kt@TҜǺ}Ua*!&9kUud4,7yJl:(NB<ƿ>lRu<lYbB,nW2hSZ5\͸[ٜ۸]iΝý<P*[GaqJqXq\JsK~*\~%#jK.WyݦbS7Tip o*E)nW?lXTũs|JmY%vJ$TuC]4F*-NV}aWa]6@J zP~TڎUyP\5U!J2KPڞ4 |,zSQUGZ<\uprCEKJnU ,[8 UsZ[x"ֈ!ۭ!6hZr%&vm6[mU,^-Uh h\WnE$[kۼK&ث7 w˴hT?3羖 uɖ%nvM%KAIjQO"V >fc}l[GzYw1vcv S2}],Vu7q\N:N߶d²l,Lc qackjjH LҖФ1 Цa:0L̤3U ;2LOzｽ{{oۛ+3X\,",]ˢ]=p}7+Maꙩ(䲞Y p{3XlZSi aSX}4J%yDtc6:c=K:pܓVS,~q#N&Wn^)5Ap׃]fJ.BC ̧>B0V0$ *OWqg,~2s? 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504.31998 244.40999 m 504.31998 219.42998 l S 535.66998 244.40999 m 535.66998 219.42998 l S 567.01996 267.23999 m 567.01996 219.42998 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 249.98 Tm (Lead inspector:)Tj 1 0 0 1 320.35001 249.98 Tm (Date:)Tj 0 Tr 1 0 0 1 34.05 227.14998 Tm (Megan Walker)Tj 1 0 0 1 329.63 227.14998 Tm (0)Tj 1 0 0 1 360.94998 227.14998 Tm (9)Tj 1 0 0 1 392.28 227.14998 Tm (1)Tj 1 0 0 1 423.60999 227.14998 Tm (2)Tj 1 0 0 1 454.94998 227.14998 Tm (2)Tj 1 0 0 1 486.28 227.14998 Tm (0)Tj 1 0 0 1 517.60004 227.14998 Tm (0)Tj 1 0 0 1 548.95996 227.14998 Tm (9)Tj /C2_1 10 Tf 1 0 0 1 28.35001 208.25 Tm <0003>Tj 1 0 0 1 28.35001 191.25 Tm <0003>Tj /C2_0 10 Tf 1 0 0 1 297.63998 174.25 Tm <0003>Tj 1 0 0 1 297.63998 162.17999 Tm <0003>Tj 1 0 0 1 297.63998 150.12 Tm <0003>Tj ET endstream endobj 1963 0 obj 5623 endobj 1964 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (2)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 10 Tf 0 Tr 1 0 0 1 297.63998 803.64996 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 28.35001 787.02997 Tm (This is a review of quality of outcomes that people experience in this )Tj 1 0 0 1 448.38995 787.02997 Tm (care home. We )Tj 1 0 0 1 28.35001 769.52997 Tm (believe high quality care should)Tj /T1_1 12 Tf 1 0 0 1 85.05 749.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 749.52997 Tm (Be safe)Tj /T1_1 12 Tf 1 0 0 1 85.05 733.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 733.52997 Tm (Have the right outcomes, including clinical outcomes)Tj /T1_1 12 Tf 1 0 0 1 85.05 717.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 717.52997 Tm (Be a good experience for the people that use it)Tj /T1_1 12 Tf 1 0 0 1 85.05 701.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 701.52997 Tm (Help prevent illness, and promote healthy, independent living)Tj /T1_1 12 Tf 1 0 0 1 85.05 685.52997 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 685.52997 Tm (Be available to those who need it when they need it.)Tj 1 0 0 1 28.35001 651.02997 Tm (The first part of the review gives the overall quality rating for the )Tj 1 0 0 1 427.60001 651.02997 Tm (care home:)Tj /T1_1 12 Tf 1 0 0 1 85.05 631.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 631.03998 Tm (3 stars - excellent)Tj /T1_1 12 Tf 1 0 0 1 85.05 615.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 615.03998 Tm (2 stars - good)Tj /T1_1 12 Tf 1 0 0 1 85.05 599.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 599.03998 Tm (1 star - adequate)Tj /T1_1 12 Tf 1 0 0 1 85.05 583.03998 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 583.03998 Tm (0 star - poor)Tj 1 0 0 1 28.35001 551.03998 Tm (There is also a bar chart that gives a quick way of seeing the quality o\ f care that the )Tj 1 0 0 1 28.35001 534.03998 Tm (home provides under key areas that matter to people.)Tj 1 0 0 1 28.35001 500.03998 Tm (There is a summary of what we think this service does well, what they ha\ ve improved )Tj 1 0 0 1 28.35001 483.03998 Tm (on and, where it applies, what they need to do better.)Tj 1 0 0 1 364.73999 483.03998 Tm (We use the national minimum )Tj 1 0 0 1 28.35001 466.03998 Tm (standards to describe the outcomes that people should experience.)Tj 1 0 0 1 443.20001 466.03998 Tm (National minimum )Tj 1 0 0 1 28.35001 449.03998 Tm (standards are written by the Department of Health for each type of care \ service.)Tj 1 0 0 1 28.35001 409.53998 Tm (After the summary there is more detail about our findings. The following\ table explains )Tj 1 0 0 1 28.35001 392.04999 Tm (what you will see under each outcome area.)Tj ET 22.69 383.85999 m 572.14996 383.85999 l S 22.69 50.22 m 572.14996 50.22 l S 22.7 383.85999 m 22.7 50.22 l S 572.14996 383.85999 m 572.14996 50.22 l S BT /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj 1 0 0 1 173.59 370.56 Tm (Choice of home\))Tj 1 0 0 1 31.2 340.25998 Tm (These are the outcomes that people )Tj 1 0 0 1 216.34 340.25998 Tm (staying in care homes should experience.)Tj 1 0 0 1 435.78998 340.25998 Tm (They reflect the things )Tj 1 0 0 1 31.2 328.10999 Tm (that people have said are important to them:)Tj ET 1 0.9451 0.76077 RG 82.23 w 30.60001 263.37 m 562.45001 263.37 l S 0.95294 0.95294 0.95294 RG 39.99001 w 29.47 285.60999 m 563.57001 285.60999 l S 1 1 1 RG 29.47 243.37 m 563.57001 243.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 264.48999 m 565.76996 264.48999 l S 27.27 306.72998 m 565.76996 306.72998 l S 27.27 264.48999 m 565.76996 264.48999 l S 27.27 222.25 m 565.76996 222.25 l S 28.35001 307.81 m 28.35001 221.17 l S 564.70001 307.81 m 564.70001 221.17 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 34.87 291.04999 Tm (This box tells you the outcomes that we will always inspect against when\ we do a key )Tj 1 0 0 1 34.87 273.54999 Tm (inspection)Tj /T1_0 10 Tf 1 0 0 1 95.78 273.54999 Tm (.)Tj /T1_0 12 Tf 1 0 0 1 34.87 248.81 Tm (This box tells you any additional outcomes that we may inspect against w\ hen we do a )Tj 1 0 0 1 34.87 231.31 Tm (key inspection.)Tj 0 0 0 RG 0.5 w /T1_0 10 Tf 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj 1 0 0 1 131.31999 191.8 Tm (staying in this care home experience:)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 28.35001 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76077 RG 39.99001 w 30.60001 123.34 m 562.45001 123.34 l S 1 1 1 RG 29.47 124.46001 m 563.57001 124.46001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 145.58 m 565.76996 145.58 l S 27.27 103.34 m 565.76996 103.34 l S 28.35001 146.66 m 28.35001 102.25999 l S 564.70001 146.66 m 564.70001 102.25999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 129.90001 Tm (This box tells you our opinion of what we have looked at in this outcome\ area.)Tj 1 0 0 1 517.78998 129.90001 Tm (We )Tj 1 0 0 1 34.87 112.40001 Tm (will say whether it is excellent, good, adequate or poor.)Tj 1 0 0 1 28.35001 86.53 Tm (Evidence:)Tj ET 1 0.9451 0.76077 RG 22.5 w 30.60001 63.97 m 562.45001 63.97 l S 1 1 1 RG 29.47 65.10001 m 563.57001 65.10001 l S 0.75294 0.75294 0.75294 RG 2.25 w 27.27 77.47 m 565.76996 77.47 l S 27.27 52.72 m 565.76996 52.72 l S 28.35001 78.55 m 28.35001 51.64999 l S 564.70001 78.55 m 564.70001 51.64999 l S BT /T1_0 12 Tf 1 0 0 1 34.87 61.78 Tm (This box describes the information we used to come to our judgement.)Tj ET endstream endobj 1965 0 obj 5469 endobj 1966 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (3)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj 0 Tr 1 0 0 1 28.35001 779.10004 Tm (We review the quality of the service against outcomes from the National \ Minimum )Tj 1 0 0 1 28.35001 762.10004 Tm (Standards \(NMS\).)Tj 1 0 0 1 144.87 762.10004 Tm (Those standards are written by the Department of Health for each )Tj 1 0 0 1 28.35001 745.10004 Tm (type of care service.)Tj 1 0 0 1 28.35001 705.60004 Tm (Copies of the)Tj 1 0 0 1 111.71001 705.60004 Tm (National Minimum Standards )Tj 1 0 0 1 290.48999 705.60004 Tm (\226 )Tj 1 0 0 1 302.34 705.60004 Tm (Care Homes for Older People)Tj 1 0 0 1 477.17999 705.60004 Tm ( can be found )Tj 1 0 0 1 28.35001 688.10999 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29,\ St Crispins, )Tj 1 0 0 1 28.35001 670.60999 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from \ the )Tj 1 0 0 1 28.35001 653.10999 Tm (Stationery Office is also available: )Tj 0 0 1 rg 1 0 0 1 238.73 653.10999 Tm (www.tso.co.uk/bookshop)Tj 0 0 0 rg 1 0 0 1 28.35001 613.12 Tm (The mission of the Care Quality Commission is to make care better for pe\ ople by:)Tj /T1_1 12 Tf 1 0 0 1 85.05 596.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 596.12 Tm (Regulating health and adult social care services to ensure quality and s\ afety )Tj 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj /T1_1 12 Tf 1 0 0 1 85.05 564.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 564.12 Tm (Protecting the rights of people who use services, particularly the most \ )Tj 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj /T1_1 12 Tf 1 0 0 1 85.05 532.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 532.12 Tm (Providing accessible, trustworthy information on the quality of care and\ )Tj 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so tha\ t )Tj 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj /T1_1 12 Tf 1 0 0 1 85.05 484.12 Tm (\267)Tj /T1_0 12 Tf 1 0 0 1 100.35001 484.12 Tm (Providing independent public accountability on how commissioners and )Tj 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing va\ lue )Tj 1 0 0 1 99.25 452.12 Tm (for money.)Tj /C2_0 14 Tf 1 0 0 1 28.35001 390.28 Tm <0035004800440047004800550003002C0051004900520055005000440057004C00520051>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35001 368.85001 m 224.04999 368.85001 l S 1 1 1 RG 226.3 368.85001 m 567 368.85001 l S 0.95294 0.95294 0.95294 RG 28.35001 346.01999 m 224.04999 346.01999 l S 1 1 1 RG 226.3 346.01999 m 567 346.01999 l S 0.95294 0.95294 0.95294 RG 28.35001 323.19 m 224.04999 323.19 l S 1 1 1 RG 226.3 323.19 m 567 323.19 l S 0.95294 0.95294 0.95294 RG 28.35001 300.35999 m 224.04999 300.35999 l S 1 1 1 RG 226.3 300.35999 m 567 300.35999 l S 0.95294 0.95294 0.95294 RG 137.22 w 28.35001 219.20999 m 224.04999 219.20999 l S 1 1 1 RG 226.3 219.20999 m 567 219.20999 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 129.27 m 224.04999 129.27 l S 1 1 1 RG 226.3 129.27 m 567 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 380.25998 m 569.20001 380.25998 l S 26.14 357.42999 m 569.20001 357.42999 l S 26.14 334.60001 m 569.20001 334.60001 l S 26.14 311.76999 m 569.20001 311.76999 l S 26.14 288.94 m 569.20001 288.94 l S 26.14 149.47 m 569.20001 149.47 l S 26.14 109.06 m 569.20001 109.06 l S 27.22 381.34 m 27.22 107.99001 l S 225.17 381.34 m 225.17 107.99001 l S 568.12 381.34 m 568.12 107.99001 l S BT /T1_0 12 Tf 1 0 0 1 31.2 364.07999 Tm (Document Purpose)Tj 1 0 0 1 229.14998 364.07999 Tm (Inspection report)Tj 1 0 0 1 31.2 341.25 Tm (Author)Tj 1 0 0 1 229.14998 341.25 Tm (Care Quality Commission)Tj 1 0 0 1 31.2 318.41998 Tm (Audience)Tj 1 0 0 1 229.14998 318.41998 Tm (General public)Tj 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj 1 0 0 1 229.14998 295.59 Tm (0870 240 7535 \(telephone order line\))Tj 1 0 0 1 31.2 272.75998 Tm (Copyright)Tj 1 0 0 1 229.14998 272.75998 Tm (Copyright \251 \(2009\) Care Quality Commission \(CQC\). )Tj 1 0 0 1 229.14998 258.17999 Tm (This publication may be reproduced in whole or in part, )Tj 1 0 0 1 229.14998 243.60001 Tm (free of charge, in any format or medium provided that )Tj 1 0 0 1 229.14998 229.01999 Tm (it is not used for commercial gain. This consent is )Tj 1 0 0 1 229.14998 214.44 Tm (subject to the material being reproduced accurately )Tj 1 0 0 1 229.14998 199.86 Tm (and on proviso that it is not used in a derogatory )Tj 1 0 0 1 229.14998 185.28 Tm (manner or misleading context. The material should be )Tj 1 0 0 1 229.14998 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj 1 0 0 1 229.14998 156.12 Tm (of publication of the document specified.)Tj 1 0 0 1 31.2 133.28999 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 133.28999 Tm (www.cqc.org.uk)Tj ET endstream endobj 1967 0 obj 8855 endobj 1968 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (4)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <002C0051004900520055005000440057004C0052005100030044004500520058005700030057004B0048000300460044005500480003004B005200500048>Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 774.21997 m 267.94998 774.21997 l S 1 1 1 RG 270.20001 774.21997 m 565.64996 774.21997 l S 0.95294 0.95294 0.95294 RG 90.90001 w 31.2 716.22998 m 267.94998 716.22998 l S 1 1 1 RG 270.20001 716.22998 m 565.64996 716.22998 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 658.23999 m 267.94998 658.23999 l S 1 1 1 RG 270.20001 658.23999 m 565.64996 658.23999 l S 0.95294 0.95294 0.95294 RG 31.2 635.40997 m 267.94998 635.40997 l S 1 1 1 RG 270.20001 635.40997 m 565.64996 635.40997 l S 0.95294 0.95294 0.95294 RG 31.2 612.57996 m 267.94998 612.57996 l S 1 1 1 RG 270.20001 612.57996 m 565.64996 612.57996 l S 0.95294 0.95294 0.95294 RG 31.2 589.75 m 267.94998 589.75 l S 1 1 1 RG 270.20001 589.75 m 565.64996 589.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 762.79999 m 567.84998 762.79999 l S 28.99001 669.64996 m 567.84998 669.64996 l S 28.99001 646.82001 m 567.84998 646.82001 l S 28.99001 623.98999 m 567.84998 623.98999 l S 28.99001 601.15997 m 567.84998 601.15997 l S 28.99001 785.63 m 567.84998 785.63 l S 28.99001 762.79999 m 567.84998 762.79999 l S 28.99001 669.64996 m 567.84998 669.64996 l S 28.99001 646.82001 m 567.84998 646.82001 l S 28.99001 623.98999 m 567.84998 623.98999 l S 28.99001 601.15997 m 567.84998 601.15997 l S 28.99001 578.33002 m 567.84998 578.33002 l S 30.07001 786.70996 m 30.07001 577.26001 l S 269.07001 786.70996 m 269.07001 577.26001 l S 566.76996 786.70996 m 566.76996 577.26001 l S BT /T1_0 12 Tf 1 0 0 1 34.05 769.45001 Tm (Name of care home:)Tj 1 0 0 1 273.04999 769.45001 Tm (The Manor House)Tj 1 0 0 1 34.05 746.62 Tm (Address:)Tj 1 0 0 1 273.04999 746.62 Tm (135 Loosleigh Lane)Tj 1 0 0 1 273.04999 729.03998 Tm (Derriford)Tj 1 0 0 1 273.04999 711.45996 Tm (Plymouth)Tj 1 0 0 1 273.04999 693.88 Tm (Devon)Tj 1 0 0 1 273.04999 676.29999 Tm (PL6 5JE)Tj 1 0 0 1 34.05 653.46997 Tm (Telephone number:)Tj 1 0 0 1 273.04999 653.46997 Tm (01752777572)Tj 1 0 0 1 34.05 630.64001 Tm (Fax number:)Tj 1 0 0 1 273.04999 630.64001 Tm (01572776628)Tj 1 0 0 1 34.05 607.81 Tm (Email address:)Tj 1 0 0 1 273.04999 607.81 Tm (kathy@man-house.co.uk)Tj 1 0 0 1 34.05 584.97998 Tm (Provider web address:)Tj /T1_0 10 Tf 1 0 0 1 28.35001 566.02997 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 66.24001 w 32.32001 522.58997 m 564.76996 522.58997 l S 1 1 1 RG 20.58 w 355.5 546.53998 m 565.90002 546.53998 l S 0.95294 0.95294 0.95294 RG 31.2 523.70996 m 353.25 523.70996 l S 1 1 1 RG 355.5 523.70996 m 565.90002 523.70996 l S 0.95294 0.95294 0.95294 RG 31.2 500.87985 m 353.25 500.87985 l S 1 1 1 RG 355.5 500.87985 m 565.90002 500.87985 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 557.95996 m 568.10004 557.95996 l S 28.99001 535.13 m 568.10004 535.13 l S 28.99001 512.29999 m 568.10004 512.29999 l S 28.99001 489.47 m 568.10004 489.47 l S 30.07001 559.02997 m 30.07001 488.38989 l S 354.37 559.02997 m 354.37 488.38989 l S 567.01996 559.02997 m 567.01996 488.38989 l S BT /T1_0 12 Tf 1 0 0 1 34.05 541.76996 Tm (Name of registered provider\(s\):)Tj 1 0 0 1 355.5 541.76996 Tm (South West Care Homes Limited)Tj 1 0 0 1 34.05 518.94 Tm (Type of registration:)Tj 1 0 0 1 358.35001 518.94 Tm (care home)Tj 1 0 0 1 34.05 496.10999 Tm (Number of places registered:)Tj 1 0 0 1 358.35001 496.10999 Tm (30)Tj /T1_0 10 Tf 1 0 0 1 28.35001 477.16998 Tm (\240)Tj 1 0 0 1 28.35001 460.16998 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 63.99001 w 32.32001 417.84998 m 564.46997 417.84998 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 429.25998 m 567.79999 429.25998 l S 28.99001 452.09 m 567.79999 452.09 l S 28.99001 429.25998 m 567.79999 429.25998 l S 28.99001 385.85001 m 567.79999 385.85001 l S 30.07001 453.16998 m 30.07001 384.76999 l S 298.32001 430.34 m 298.32001 384.76999 l S 566.71997 453.16998 m 566.71997 384.76999 l S BT /T1_0 12 Tf 1 0 0 1 34.05 435.91 Tm (Conditions of registration:)Tj 1 0 0 1 34.05 413.07999 Tm (Category\(ies\) :)Tj 1 0 0 1 302.30002 413.07999 Tm (Number of places \(if applicable\):)Tj 1 0 0 1 302.30002 392.5 Tm (Under 65)Tj 1 0 0 1 435.37 392.5 Tm (Over 65)Tj ET 1 1 1 RG 20.58 w 31.2 371.06 m 297.30002 371.06 l S 299.54999 371.06 m 431.44998 371.06 l S 433.70001 371.06 m 565.60004 371.06 l S 35.16 w 31.2 340.94 m 297.30002 340.94 l S 299.54999 340.94 m 431.44998 340.94 l S 433.70001 340.94 m 565.60004 340.94 l S 0.95294 0.95294 0.95294 RG 20.58 w 31.2 310.82001 m 565.60004 310.82001 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 567.79999 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 382.47998 m 567.79999 382.47998 l S 28.99001 359.64999 m 567.79999 359.64999 l S 28.99001 322.23999 m 567.79999 322.23999 l S 28.99001 299.41 m 568.10004 299.41 l S 28.99001 276.57999 m 568.10004 276.57999 l S 28.99001 210.00998 m 568.10004 210.00998 l S 30.07001 383.54999 m 30.07001 208.92998 l S 298.41998 383.54999 m 298.41998 321.16 l S 432.56998 383.54999 m 432.56998 321.16 l S 566.71997 383.54999 m 566.71997 208.92998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 366.28998 Tm (dementia)Tj 1 0 0 1 302.39999 366.28998 Tm (30)Tj 1 0 0 1 436.54999 366.28998 Tm (0)Tj 1 0 0 1 34.05 343.45999 Tm (old age, not falling within any other )Tj 1 0 0 1 34.05 328.88 Tm (category)Tj 1 0 0 1 302.39999 343.45999 Tm (0)Tj 1 0 0 1 436.54999 343.45999 Tm (30)Tj 1 0 0 1 34.05 306.04999 Tm (Additional conditions: )Tj 1 0 0 1 34.05 283.22 Tm (The maximum number of service users who can be accommodated is 30)Tj 1 0 0 1 34.05 260.38998 Tm (The registered person may provide the following category of service only\ : Care Home )Tj 1 0 0 1 34.05 245.81 Tm (only - Code PC to service users of either gender whose primary care need\ s are within )Tj 1 0 0 1 34.05 231.23 Tm (the following categories: Old age, not falling within any other catetgor\ y \(Code OP\) )Tj 1 0 0 1 34.05 216.64998 Tm (Dementia \(Code DE\))Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 195.22 m 315.25 195.22 l S 1 1 1 RG 317.5 195.22 m 346.54999 195.22 l S 348.80002 195.22 m 377.89999 195.22 l S 380.14999 195.22 m 409.20001 195.22 l S 411.44998 195.22 m 440.54999 195.22 l S 442.80002 195.22 m 471.89993 195.22 l S 474.14993 195.22 m 503.20001 195.22 l S 505.44998 195.22 m 534.54999 195.22 l S 536.79999 195.22 m 565.90002 195.22 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 206.62999 m 568.10004 206.62999 l S 28.99001 183.8 m 568.10004 183.8 l S 30.07001 207.70999 m 30.07001 182.73 l S 316.37 207.70999 m 316.37 182.73 l S 347.66998 207.70999 m 347.66998 182.73 l S 379.01999 207.70999 m 379.01999 182.73 l S 410.31998 207.70999 m 410.31998 182.73 l S 441.66998 207.70999 m 441.66998 182.73 l S 473.01999 207.70999 m 473.01999 182.73 l S 504.31998 207.70999 m 504.31998 182.73 l S 535.66998 207.70999 m 535.66998 182.73 l S 567.01996 207.70999 m 567.01996 182.73 l S BT /T1_0 12 Tf 1 0 0 1 34.05 190.45 Tm (Date of last inspection)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 171.92999 m 565.90002 171.92999 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 162.3 m 568.10004 162.3 l S 30.07001 163.37999 m 30.07001 39.14999 l S 567.01996 163.37999 m 567.01996 39.14999 l S 28.99001 181.55 m 568.10004 181.55 l S 28.99001 162.3 m 568.10004 162.3 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 182.62999 m 30.07001 161.23 l S 567.01996 182.62999 m 567.01996 161.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 168.37 Tm (Brief description of the )Tj 1 0 0 1 177.31 168.37 Tm (care home)Tj 1 0 0 1 35.5 149.12 Tm (The Manor House is registered with the Care Quality Commission to provid\ e residential )Tj 1 0 0 1 35.5 132.12 Tm (accommodation and personal care, for up to 30 persons for reasons of age\ and who )Tj 1 0 0 1 35.5 115.12 Tm (may also have a dementia. The home does not provide intermediate care an\ d it is not )Tj 1 0 0 1 35.5 98.12 Tm (registered to provide nursing care. South West Care Homes Limited owns T\ he Manor )Tj 1 0 0 1 35.5 81.12 Tm (House. It is one of eleven care homes owned by the company across Plymou\ th, )Tj 1 0 0 1 35.5 64.12 Tm (Cornwall and Somerset.)Tj 1 0 0 1 35.5 47.12 Tm (The Manor House is located in the Derriford area of Plymouth, close to t\ he hospital, )Tj ET endstream endobj 1969 0 obj 2934 endobj 1970 0 obj<>stream 0.8 0.8 0.8 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 485.41998 30.78999 Tm (Page)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 515.95001 30.78999 Tm (5)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 523.58002 30.78999 Tm ( of )Tj /T1_0 12 Tf 2 Tr 1 0 0 1 541.88 30.78999 Tm (44)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 804.02997 m 565.90002 804.02997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 794.40002 m 568.10004 794.40002 l S 30.07001 795.47998 m 30.07001 519.08002 l S 567.01996 795.47998 m 567.01996 519.08002 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 520.14996 m 568.10004 520.14996 l S 30.07001 814.72998 m 30.07001 793.32996 l S 567.01996 814.72998 m 567.01996 793.32996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.5 800.46997 Tm (Brief description of the )Tj 1 0 0 1 177.31 800.46997 Tm (care home)Tj 1 0 0 1 33.25 783.46997 Tm (transport routes and other amenities. The home consists of a detached tw\ o-storey )Tj 1 0 0 1 33.25 766.46997 Tm (house with a two-storey extension and has been modified with ramps and a\ shaft lift. )Tj 1 0 0 1 33.25 749.46997 Tm (Thee are twenty-eight single bedrooms - sixteen on the ground floor and \ twelve on the )Tj 1 0 0 1 33.25 732.46997 Tm (first floor. There is one shared room on the first floor. Seventeen bedr\ ooms have )Tj 1 0 0 1 527.90997 732.46997 Tm (en-)Tj 1 0 0 1 33.25 715.46997 Tm (suite)Tj 1 0 0 1 62.25999 715.46997 Tm ( toilets. Bathing, showering and toilet facilities are available on each\ floor, close to )Tj 1 0 0 1 33.25 698.46997 Tm (bedrooms and communal rooms. There are lounge and dining rooms on the gr\ ound )Tj 1 0 0 1 33.25 681.46997 Tm (floor, as well as a smaller lounge with a dining table. There is a call \ bell system )Tj 1 0 0 1 33.25 664.46997 Tm (installed throughout the home. The home has a large garden at the rear a\ nd there is )Tj 1 0 0 1 33.25 647.46997 Tm (car parking at the front of the home and on street parking is available \ nearby.)Tj 1 0 0 1 33.25 630.46997 Tm (Weekly fees range from \243359.28 to \243494.33 per week, and are accord\ ing to )Tj 1 0 0 1 33.25 613.46997 Tm (assessment of the person's individual care needs. Additional charges inc\ lude )Tj 1 0 0 1 33.25 596.46997 Tm (hairdressing, chiropody, toiletries, newspapers, magazines, journals etc\ , all charged at )Tj 1 0 0 1 33.25 579.46997 Tm (commercial rates, and escort for hospital and GP appointments. Written i\ nformation )Tj 1 0 0 1 33.25 562.46997 Tm (including information about additional charges is available for people c\ onsidering going )Tj 1 0 0 1 33.25 545.46997 Tm (to live at The Manor House and for those who are resident. A copy of the\ most recent )Tj 1 0 0 1 33.25 528.46997 Tm (inspection report is available from the home.)Tj ET endstream endobj 1971 0 obj 3668 endobj 1972 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (6)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj /C2_0 14 Tf 0 Tr 1 0 0 1 28.35001 795.64996 Tm <003600580050005000440055005C>Tj /T1_0 12 Tf 1 0 0 1 28.35001 774.70001 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.21997 m 381.04999 754.21997 l S 1 1 1 RG 383.30002 754.21997 m 566.20001 754.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 765.63995 m 568.40002 765.63995 l S 28.99001 742.81 m 568.40002 742.81 l S 30.07001 766.70996 m 30.07001 741.72998 l S 382.16998 766.70996 m 382.16998 741.72998 l S 567.32001 766.70996 m 567.32001 741.72998 l S BT /T1_0 12 Tf 1 0 0 1 34.05 749.45001 Tm (The quality rating for this )Tj 1 0 0 1 191.92 749.45001 Tm (care home)Tj 1 0 0 1 255.59 749.45001 Tm ( is:)Tj 1 0 0 1 410.5 749.45001 Tm (zero star poor service)Tj /C2_0 12 Tf 1 0 0 1 28.35001 717.31 Tm <0032005800550003004D00580047004A0048005000480051005700030049005200550003004800440046004B00030052005800570046005200500048001D>Tj /T1_0 10 Tf 1 0 0 1 212.28998 641.26996 Tm (Choice of home)Tj 1 0 0 1 164.41 601.01996 Tm (Health and personal care)Tj 1 0 0 1 145.17999 560.76996 Tm (Daily life and social activities)Tj 1 0 0 1 157.95 520.51996 Tm (Complaints and protection)Tj 1 0 0 1 226.36 480.26999 Tm (Environment)Tj 1 0 0 1 251.17 440.01999 Tm (Staffing)Tj 1 0 0 1 127.47 399.76999 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75162 305.04999 334.32001 cm /Fm0 Do Q 1 1 1 RG 20.58 w 31.2 283.07999 m 567.84998 283.07999 l S 206.50998 w 32.32001 167.28 m 566.71997 167.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 271.66 m 567.84998 271.66 l S 30.12 271.66 m 568.91998 271.66 l S 30.12 62.90001 m 568.91998 62.90001 l S 31.2 272.73999 m 31.2 61.82001 l S 567.84998 272.73999 m 567.84998 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 2 Tr 1 0 0 1 34.05 278.30002 Tm (How we did our inspection:)Tj 0 Tr 1 0 0 1 35.17 255.48 Tm (The quality rating for this service is zero stars. This means the people\ who use this )Tj 1 0 0 1 35.17 240.90001 Tm (service experience poor quality outcomes. This unannounced inspection vi\ sit took place )Tj 1 0 0 1 35.17 226.31998 Tm (on 9th December 2009 between 09:00 and 19:00 by one Regulation Inspector\ . A )Tj 1 0 0 1 35.17 211.73999 Tm (Pharmacy Inspector was present for part of this visit specifically to lo\ ok at issues about )Tj 1 0 0 1 35.17 197.14998 Tm (medication. The last key inspection took place on 22nd March 2007. This \ report is )Tj 1 0 0 1 35.17 182.56999 Tm (written on behalf of the Care Quality Commission \(CQC\).)Tj 1 0 0 1 35.17 167.98999 Tm (\240)Tj 1 0 0 1 35.17 153.41 Tm (A tour of the premises took place and records relating to care, staff an\ d the home were )Tj 1 0 0 1 35.17 138.84 Tm (inspected. We met people who live at the home in the lounges, dining roo\ m, and in )Tj 1 0 0 1 35.17 124.25 Tm (their bedrooms. We looked at how medication is administered, recorded an\ d stored.)Tj 1 0 0 1 35.17 109.68001 Tm (\240)Tj 1 0 0 1 35.17 95.10001 Tm (The registered manager left the Manor House in the autumn 2009. A new pe\ rson has )Tj 1 0 0 1 35.17 80.50999 Tm (been appointed to take day to day responsibility for the home, and has b\ een in post )Tj 1 0 0 1 35.17 65.93001 Tm (since November 2009. In the report this person is referred to "as the pe\ rson in )Tj ET endstream endobj 1973 0 obj 1865 endobj 1974 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (7)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 207.12 w 32.32001 708.96997 m 566.71997 708.96997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 604.27997 m 568.91998 604.27997 l S 31.2 814.72998 m 31.2 603.20996 l S 567.84998 814.72998 m 567.84998 603.20996 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (charge". This person was available throughout the visit for consultation\ and )Tj 1 0 0 1 32.92 788.13995 Tm (information. The registered provider joined us for the latter part of th\ e visit.)Tj 1 0 0 1 32.92 773.56 Tm (\240)Tj 1 0 0 1 32.92 758.97998 Tm (We received an Annual Quality Assurance Assessment \(AQAA\). The AQAA is\ a )Tj 1 0 0 1 507.75 758.97998 Tm (self-)Tj 1 0 0 1 32.92 744.40002 Tm (assessment)Tj 1 0 0 1 103.44 744.40002 Tm ( that focuses on how well outcomes are met for the people who live in th\ e )Tj 1 0 0 1 32.92 729.82001 Tm (home.)Tj 1 0 0 1 32.92 715.23999 Tm (\240)Tj 1 0 0 1 32.92 700.65997 Tm (We sent surveys for completion by people who use this service or their )Tj 1 0 0 1 32.92 686.07996 Tm (relatives/advocates, staff, and health and social care professionals. No\ ne had been )Tj 1 0 0 1 32.92 671.5 Tm (returned at the time of writing this report.)Tj 1 0 0 1 32.92 656.91998 Tm (\240)Tj 1 0 0 1 32.92 642.33997 Tm (All this information helps us to develop a picture of how the home is ma\ naged and )Tj 1 0 0 1 32.92 627.76001 Tm (what it is like to live at the Manor House.)Tj 1 0 0 1 32.92 613.17999 Tm (\240)Tj ET endstream endobj 1975 0 obj 6632 endobj 1976 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (8)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 93.48 w 32.32001 727.07996 m 566.71997 727.07996 l S 20.58 w 32.7 667.79999 m 569.34998 667.79999 l S 78.90001 w 33.82001 615.81 m 568.21997 615.81 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 487.25998 w 34.57001 307.64999 m 568.96997 307.64999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.2 774.95001 m 567.84998 774.95001 l S 30.12 774.95001 m 568.91998 774.95001 l S 30.12 679.21997 m 568.91998 679.21997 l S 31.2 776.02997 m 31.2 678.14001 l S 31.2 679.21997 m 569.34998 679.21997 l S 32.7 656.39001 m 569.34998 656.39001 l S 31.62 656.39001 m 570.41998 656.39001 l S 31.62 575.23999 m 570.41998 575.23999 l S 33.45 552.40997 m 570.10004 552.40997 l S 33.45 575.23999 m 570.10004 575.23999 l S 32.37 552.40997 m 571.16998 552.40997 l S 32.37 62.90001 m 571.16998 62.90001 l S 32.7 657.46997 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 61.82001 l S 567.84998 776.02997 m 567.84998 678.14001 l S 569.34998 657.46997 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 61.82001 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 31.2 781.58997 Tm (What the )Tj 1 0 0 1 90.52 781.58997 Tm (care home)Tj 1 0 0 1 154.2 781.58997 Tm ( does well:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 567.84998 784.25 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 35.17 758.76001 Tm (The appointment of someone new to take charge of the day to day responsi\ bility of the )Tj 1 0 0 1 35.17 744.17999 Tm (management of the Manor House shows promise and signs of good leadership\ .)Tj 1 0 0 1 35.17 729.60004 Tm (\240)Tj 1 0 0 1 35.17 715.01996 Tm (The newly appointed person in charge has responded well to the findings \ of this key )Tj 1 0 0 1 35.17 700.44 Tm (inspection. Action to meet the requirments and recommendations of this r\ eport has )Tj 1 0 0 1 35.17 685.85999 Tm (been positive and timely.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 725.52997 Tm (\240)Tj 1 0 0 1 31.2 665.69 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 663.02997 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 666.25 Tm (\240)Tj 1 0 0 1 31.2 614.26001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 640.20001 Tm (Since the last inspection a new conservatory has been built and furnishe\ d. The rolling )Tj 1 0 0 1 36.67 625.62 Tm (schedule of refurbishment continues with the redecoration of bedrooms, r\ enewal of )Tj 1 0 0 1 36.67 611.03998 Tm (flooring and furniture where needed. The fire system has been upgraded. \ New laundry )Tj 1 0 0 1 36.67 596.45996 Tm (equipment has been installed and the dishwasher has been upgraded to a c\ ommercial )Tj 1 0 0 1 36.67 581.88 Tm (one. New pumps have been installed to upgrade the hot water and heating \ system.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 614.26001 Tm (\240)Tj 1 0 0 1 31.2 562.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 33.45 559.04999 Tm (What they could do better:)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 31.2 306.10999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (The health,safety and well being of everyone who uses this service must \ be the main )Tj 1 0 0 1 37.42 521.64001 Tm (priority of the registered provider. This can be done by ensuring all st\ aff are fully )Tj 1 0 0 1 37.42 507.06 Tm (trained in all aspects of care, including recognising and reporting abus\ ive practice, fire )Tj 1 0 0 1 37.42 492.47998 Tm (safety, moving and handling, first aid, infection control, and health an\ d safety. This will )Tj 1 0 0 1 37.42 477.89993 Tm (ensure that all the staff care for vulnerable people in a safe and effec\ tive way which )Tj 1 0 0 1 37.42 463.31998 Tm (does not place them at risk.)Tj 1 0 0 1 37.42 448.73999 Tm (\240)Tj 1 0 0 1 37.42 434.16 Tm (People who use the service must be safe at all times. They must have eas\ y access to a )Tj 1 0 0 1 37.42 419.57999 Tm (call bell \(it is within their reach\), or systems must be in place to e\ nsure people who are )Tj 1 0 0 1 37.42 405 Tm (unable to use or access a bell are safe.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Consultation with an Occupational Therapist would provide the registered\ provider with )Tj 1 0 0 1 37.42 361.25998 Tm (an assessment and advice about how the home and gardens could be as acce\ ssible as )Tj 1 0 0 1 37.42 346.67999 Tm (possible for the people using the service and thereby increase their ind\ ependence.)Tj 1 0 0 1 37.42 332.10001 Tm (\240)Tj 1 0 0 1 37.42 317.51999 Tm (Before someone comes to live at the Manor House a thorough assessment of\ their )Tj 1 0 0 1 37.42 302.94 Tm (health and social care needs must be carried out to ensure that the home\ is suitable, )Tj 1 0 0 1 37.42 288.35999 Tm (that any required equipment is available, and that the staff team are ex\ perienced, )Tj 1 0 0 1 37.42 273.78 Tm (skilled and competent to meet the person's needs. These assessments need\ to be )Tj 1 0 0 1 37.42 259.20001 Tm (documented and include all aspects of personal, health, psychological an\ d social care )Tj 1 0 0 1 37.42 244.62 Tm (needs to ensure that people's needs are fully identified.)Tj 1 0 0 1 37.42 230.03998 Tm (\240)Tj 1 0 0 1 37.42 215.45999 Tm (Once a person moves into a care home, or before, a care and support plan\ has to be )Tj 1 0 0 1 37.42 200.87999 Tm (developed with the person and/or relatives and representatives. This is \ to agree what )Tj 1 0 0 1 37.42 186.3 Tm (care the person needs and how the staff team should support them. The ca\ re plans in )Tj 1 0 0 1 37.42 171.72 Tm (the home need to include all aspects of people's care needs and how the \ staff should )Tj 1 0 0 1 37.42 157.14 Tm (meet those needs. The plans should include risk assessments for those pe\ ople deemed )Tj 1 0 0 1 37.42 142.56 Tm (to be at risk of falling, night-time routines, communication needs and d\ etails of )Tj 1 0 0 1 37.42 127.98 Tm (people's social activities, interests, hobbies and aspirations. Care pla\ ns should be )Tj 1 0 0 1 37.42 113.40001 Tm (signed by the people who live in the home and/or relatives/representativ\ es to show )Tj 1 0 0 1 37.42 98.82001 Tm (that they have been involved in drawing up the plan and are aware of the\ content.)Tj 1 0 0 1 37.42 84.24001 Tm (\240)Tj 1 0 0 1 37.42 69.66 Tm (Care Plans must also be improved to show that care has been reviewed and\ reflects )Tj ET endstream endobj 1977 0 obj 5629 endobj 1978 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (9)Tj 0 Tr 1 0 0 1 515.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 533.48999 31.8 Tm (44)Tj ET 1 1 1 RG 748.5 w 34.57001 438.28 m 568.96997 438.28 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 62.90001 m 571.16998 62.90001 l S 33.45 814.72998 m 33.45 61.82001 l S 570.10004 814.72998 m 570.10004 61.82001 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (the care that is actually given. Care records must be accurate. These im\ provements )Tj 1 0 0 1 35.17 788.13995 Tm (will mean that care staff have accurate records and will be able to prov\ ide care in a )Tj 1 0 0 1 35.17 773.56 Tm (safe and consistent way. Care records should be informative and portray \ a positive )Tj 1 0 0 1 35.17 758.97998 Tm (picture of people's daily life.)Tj 1 0 0 1 35.17 744.40002 Tm (\240)Tj 1 0 0 1 35.17 729.82001 Tm (Any equipment that is used in the home must be well maintained. Use of e\ quipment )Tj 1 0 0 1 35.17 715.23999 Tm (such as bed rails and electronic devices to detect anyone who may be wan\ dering, must )Tj 1 0 0 1 35.17 700.65997 Tm (be assessed to ensure these are safe to use and is the only method that \ can keep a )Tj 1 0 0 1 35.17 686.07996 Tm (person safe. Records must show why any equipment is in use and that good\ practice )Tj 1 0 0 1 35.17 671.5 Tm (guidelines are being followed. Records must show that equipment that can\ be classed )Tj 1 0 0 1 35.17 656.91998 Tm (as restraint is only used in someone's best interests.)Tj 1 0 0 1 35.17 642.33997 Tm (\240)Tj 1 0 0 1 35.17 627.76001 Tm (Mealtimes should be leisurely, at times that suit the people living in t\ he home. They )Tj 1 0 0 1 35.17 613.17999 Tm (should be presented in a way that is attractive and appealing in terms o\ f texture, )Tj 1 0 0 1 35.17 598.60004 Tm (flavour and appearance, in order to maintain appetite and nutrition. Mor\ e social )Tj 1 0 0 1 35.17 584.01996 Tm (activities and outings should be provided, as well as engaging residents\ in activities of )Tj 1 0 0 1 35.17 569.44 Tm (daily life in the home.)Tj 1 0 0 1 35.17 554.85999 Tm (\240)Tj 1 0 0 1 35.17 540.27997 Tm (Infection control practices must be improved in the home to reduce the s\ pread of )Tj 1 0 0 1 35.17 525.70001 Tm (infection in vulnerable people. The registered provider should seek the \ advice of the )Tj 1 0 0 1 35.17 511.12 Tm (Health Protection Agency and ensure staff receive training in the use of\ personal )Tj 1 0 0 1 35.17 496.53998 Tm (protective equipment. As well as ensuring staff are aware of how to redu\ ce infection, )Tj 1 0 0 1 35.17 481.95999 Tm (the cleanliness of the home must improved for the same purpose.)Tj 1 0 0 1 35.17 467.37991 Tm (\240)Tj 1 0 0 1 35.17 452.80002 Tm (Staff must be aware of how to correctly report allegations of abuse to t\ he local )Tj 1 0 0 1 35.17 438.22 Tm (safeguarding team and be aware of how to report poor practice. This will\ protect )Tj 1 0 0 1 35.17 423.63998 Tm (people by making sure allegations are reported correctly and poor manage\ ment does )Tj 1 0 0 1 35.17 409.06 Tm (not affect any investigation that needs to take place. Staff must also b\ e aware of what )Tj 1 0 0 1 35.17 394.47998 Tm (the Mental Capacity Act is and how their care practices could be seen as\ restraint. The )Tj 1 0 0 1 35.17 379.89999 Tm (use of restraint must only be used as a last resort and where the use is\ in the best )Tj 1 0 0 1 35.17 365.31998 Tm (interest of the person and not for the convenience of staff.)Tj 1 0 0 1 35.17 350.73999 Tm (\240)Tj 1 0 0 1 35.17 336.16 Tm (The Provider must keep staffing levels under review to ensure that peopl\ e have their )Tj 1 0 0 1 35.17 321.57999 Tm (care needs met in a way that respects their privacy and dignity. This re\ view must also )Tj 1 0 0 1 35.17 307 Tm (include the mix of staff skills and duties they are expected to achieve \ during each shift.)Tj 1 0 0 1 35.17 292.41998 Tm (\240)Tj 1 0 0 1 35.17 277.84 Tm (The Provider must introduce changes in care practices to ensure that the\ people who )Tj 1 0 0 1 35.17 263.25998 Tm (live at the Manor House are respected as individuals by the manner in wh\ ich they are )Tj 1 0 0 1 35.17 248.67998 Tm (addressed and treated.)Tj 1 0 0 1 35.17 234.10001 Tm (\240)Tj 1 0 0 1 35.17 219.51999 Tm (The training and induction programme must improve in the home. Staff mus\ t all be up )Tj 1 0 0 1 35.17 204.94 Tm (to date with both mandatory training and additional training needed to c\ are for people )Tj 1 0 0 1 35.17 190.36 Tm (in a safe way. Improvements in induction and supervision programmes woul\ d also )Tj 1 0 0 1 35.17 175.78 Tm (provide staff with the support and information to work in a safe and res\ pectful way. )Tj 1 0 0 1 35.17 161.2 Tm (Supervision of staff at all levels would also mean poor practice could b\ e addressed.)Tj 1 0 0 1 35.17 146.62 Tm (\240)Tj 1 0 0 1 35.17 132.03999 Tm (Staff must be made aware of how to correctly report incidents to the CQC\ . Accident )Tj 1 0 0 1 35.17 117.46001 Tm (records should be stored correctly to ensure the management of records i\ s robust.)Tj 1 0 0 1 35.17 102.88 Tm (\240)Tj 1 0 0 1 35.17 88.3 Tm (Improvements are needed to the way medicines are handled in the home, to\ make )Tj 1 0 0 1 35.17 73.72 Tm (sure people always receive their medicines safely as their doctor has pr\ escribed for )Tj ET endstream endobj 1979 0 obj 1466 endobj 1980 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 1 1 1 RG 32.16 w 34.57001 796.45001 m 568.96997 796.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 32.37 813.64996 m 571.16998 813.64996 l S 32.37 779.23999 m 571.16998 779.23999 l S 33.45 814.72998 m 33.45 778.16998 l S 570.10004 814.72998 m 570.10004 778.16998 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 35.17 802.71997 Tm (them.)Tj 1 0 0 1 35.17 788.13995 Tm (\240)Tj 1 0 0 1 28.35001 764.67999 Tm (\240)Tj 1 0 0 1 28.35001 744.69 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 744.69 Tm (care home)Tj 1 0 0 1 480.03998 744.69 Tm ( is taking )Tj 1 0 0 1 28.35001 727.19 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 707.20001 Tm (\240)Tj 1 0 0 1 28.35001 687.20001 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 687.20001 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 667.20001 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 667.20001 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 647.20996 Tm (order line 0870 240 7535.)Tj ET endstream endobj 1981 0 obj 1804 endobj 1982 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 14 Tf 1 0 0 1 28.35001 777.08997 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 26 w 31.2 744.14996 m 565.90002 744.14996 l S BT /C2_0 12 Tf 0 Tr 1 0 0 1 34.05 741.13995 Tm <00260052005100570048005100570056>Tj ET 1 1 1 RG 16 w 28.35001 700.14996 m 566.92999 700.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 696.08997 Tm (Choice of home\240 \(standards 1 - 6\))Tj ET 28.35001 678.14996 m 566.92999 678.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 674.08997 Tm (Health and personal care\240 \(standards 7 - 11\))Tj ET 28.35001 656.14996 m 566.92999 656.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 652.08997 Tm (Daily life and social activities\240 \(standards 12 - 15\))Tj ET 28.35001 634.14996 m 566.92999 634.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 630.08997 Tm (Complaints and protection\240 \(standards 16 - 18\))Tj ET 28.35001 612.14996 m 566.92999 612.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 608.08997 Tm (Environment\240 \(standards 19 - 26\))Tj ET 28.35001 590.14996 m 566.92999 590.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 586.08997 Tm (Staffing\240 \(standards 27 - 30\))Tj ET 28.35001 568.14996 m 566.92999 568.14996 l S BT /T1_0 12 Tf 1 0 0 1 28.35001 564.08997 Tm (Management and administration\240 \(standards 31 - 38\))Tj 1 0 0 1 28.35001 544.08997 Tm (Outstanding statutory requirements)Tj 1 0 0 1 28.35001 522.21997 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 1983 0 obj 6050 endobj 1984 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (12)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Choice of home )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.25 w 32.32001 610.38 m 562.52997 610.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 119 w 31.2 567.88 m 563.64996 567.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 507.25 m 565.84998 507.25 l S 30.07001 716.82996 m 30.07001 506.16995 l S 564.77997 716.82996 m 564.77997 506.16995 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People are confident that the care home can support them. This is becaus\ e there is an )Tj 1 0 0 1 35.5 685.57001 Tm (accurate assessment of their needs that they, or people close to them, h\ ave been )Tj 1 0 0 1 35.5 668.57001 Tm (involved in. This tells the home all about them and the support they nee\ d. People who )Tj 1 0 0 1 35.5 651.57001 Tm (stay at the home only for intermediate care, have a clear assessment tha\ t includes a )Tj 1 0 0 1 35.5 634.57001 Tm (plan on what they hope for and want to achieve when they return home.)Tj 1 0 0 1 35.5 615.32001 Tm (People can decide whether the care home can meet their support and accom\ modation )Tj 1 0 0 1 35.5 598.32001 Tm (needs. This is because they, or people close to them, have been able to \ visit the home )Tj 1 0 0 1 35.5 581.32001 Tm (and have got full, clear, accurate and up to date information about the \ home. If they )Tj 1 0 0 1 35.5 564.32001 Tm (decide to stay in the home they know about their rights and responsibili\ ties because )Tj 1 0 0 1 35.5 547.32001 Tm (there is an easy to understand contract or statement of terms and condit\ ions between )Tj 1 0 0 1 35.5 530.32001 Tm (them and the care home that includes how much they will pay and what the\ home )Tj 1 0 0 1 35.5 513.32001 Tm (provides for the money.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 489 Tm <0003>Tj 1 0 0 1 28.35001 467 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 467 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 444.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 141.84999 w 34.60001 369.25 m 562.53998 369.25 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 119.35001 w 33.47 358 m 563.65997 358 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 418.80002 m 565.87 418.80002 l S 32.35001 419.88 m 32.35001 296.12 l S 564.78998 419.88 m 564.78998 296.12 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 297.20001 m 565.87 297.20001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 427.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 403.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 403.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 385.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 358.75 Tm (The assessment process is not thorough and comprehensive prior to admiss\ ion )Tj 1 0 0 1 36.62 341.25 Tm (because staff do not always have information to decide whether they are \ able to meet )Tj 1 0 0 1 36.62 323.75998 Tm (the needs of prospective residents. This means that prospective resident\ s and their )Tj 1 0 0 1 36.62 306.25998 Tm (relatives cannot be confident that their all their care needs can be met\ .)Tj 1 0 0 1 28.35001 281.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.3 w 34.60001 176.67999 m 562.53998 176.67999 l S 1 1 1 RG 22.5 w 32.35001 262.32999 m 564.78998 262.32999 l S 167.92999 w 33.47 164.87 m 563.65997 164.87 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 249.95998 m 565.87 249.95998 l S 32.35001 251.03998 m 32.35001 78.70001 l S 564.78998 251.03998 m 564.78998 78.70001 l S 32.35001 249.95998 m 564.78998 249.95998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 259.01999 Tm (Evidence:)Tj 1 0 0 1 36.57001 234.26999 Tm (We looked at three care files. We found that one care file had an pre-as\ sessment of )Tj 1 0 0 1 36.57001 216.78 Tm (need completed by a social worker that was for provision of domiciliary \ care in the )Tj 1 0 0 1 36.57001 199.28 Tm (person's own home. Staff have not carried out their own assessment to de\ cide )Tj 1 0 0 1 36.57001 181.78998 Tm (whether they can meet that person's needs.There was no evidence to show \ why the )Tj 1 0 0 1 36.57001 164.28999 Tm (person needed twenty-four hour care. Another care file had no assessment\ of need )Tj 1 0 0 1 36.57001 146.78999 Tm (prior to admission. The third care file had a very basic pre-assessment \ completed on a )Tj 1 0 0 1 36.57001 129.3 Tm ("stand alone" proforma. This provided insufficient information on which \ to make a )Tj 1 0 0 1 537.33002 129.3 Tm (pro-)Tj 1 0 0 1 36.57001 111.8 Tm (active)Tj 1 0 0 1 72.31 111.8 Tm ( judgement as to whether the person's needs could be met at the Manor Ho\ use.)Tj 1 0 0 1 36.57001 94.31 Tm (\240)Tj ET endstream endobj 1985 0 obj 3970 endobj 1986 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (13)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 528.76001 w 34.60001 547.02997 m 562.53998 547.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 507.37985 w 33.47 535.21997 m 563.65997 535.21997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 279.32001 l S 564.78998 791.10999 m 564.78998 279.32001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 280.39999 m 565.87 280.39999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Since moving into the care home, only one of the three people had a writ\ ten care )Tj 1 0 0 1 34.32001 761.60004 Tm (plan. This provided minimal information for staff and showed that these \ )Tj 1 0 0 1 473.22998 761.60004 Tm (pre-)Tj 1 0 0 1 34.32001 744.10999 Tm (assessments)Tj 1 0 0 1 111.10001 744.10999 Tm ( were not completed in sufficient detail to show what care needs the )Tj 1 0 0 1 34.32001 726.60999 Tm (person had. This care plan was dated February 2008. We found no evidence\ of any )Tj 1 0 0 1 34.32001 709.10999 Tm (plan of care after moving into the home for the other two people.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Since the last key inspection the care home has applied for and been giv\ en an )Tj 1 0 0 1 34.32001 656.63 Tm (additional category of "DE". This means that it is now registered to pro\ vide care and )Tj 1 0 0 1 34.32001 639.13 Tm (accommodation for anyone who may have a dementia care need. The pre-asse\ ssment )Tj 1 0 0 1 34.32001 621.63 Tm (form we saw in use at the time of this inspection visit did not include \ pre-assessment )Tj 1 0 0 1 34.32001 604.14001 Tm (of this. As an information gathering form it does not help the staff to \ make a )Tj 1 0 0 1 34.32001 586.64001 Tm (comprehensive holistic assessment on which they can base a decision to o\ ffer )Tj 1 0 0 1 34.32001 569.14996 Tm (someone a place at the home. Also it does not provide an opportunity for\ the )Tj 1 0 0 1 34.32001 551.64996 Tm (prospective resident &/or family & friends to contribute information to \ ease transition )Tj 1 0 0 1 34.32001 534.14996 Tm (from home to care.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The Responsible Individual confirmed that any prospective resident would\ be given a )Tj 1 0 0 1 34.32001 481.66998 Tm (brochure about the home that clearly states the fees, the home's philoso\ phy and some )Tj 1 0 0 1 34.32001 464.16998 Tm (information about the physical environment of the care home. There is al\ so a website )Tj 1 0 0 1 34.32001 446.66998 Tm (giving more information about the company, South West Care Homes, and ab\ out the )Tj 1 0 0 1 34.32001 429.17999 Tm (Manor House.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (The Certificate of Registration and the Complaints Procedure were not ev\ ident or easy )Tj 1 0 0 1 34.32001 376.69 Tm (to read because they were both displayed in a hallway at an overhead hei\ ght. The )Tj 1 0 0 1 34.32001 359.19 Tm (Complaints procedure needed to be updated to show people clearly how the\ y can )Tj 1 0 0 1 34.32001 341.70001 Tm (contact CQC. We suggested to the Responsible Individual and the person i\ n charge )Tj 1 0 0 1 34.32001 324.20001 Tm (that it would be beneficial if both these documents were displayed in a \ more )Tj 1 0 0 1 34.32001 306.70999 Tm (prominent place, and at eye level.)Tj 1 0 0 1 34.32001 289.20999 Tm (\240)Tj ET endstream endobj 1987 0 obj 5601 endobj 1988 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (14)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Health and personal care )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 172.25 w 32.32001 627.38 m 562.52997 627.38 l S 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.64996 663.63 l S 1 1 1 RG 68 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 611.5 m 565.84998 611.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 611.5 m 565.84998 611.5 l S 28.99001 541.25 m 565.84998 541.25 l S 30.07001 716.82996 m 30.07001 540.16998 l S 564.77997 716.82996 m 564.77997 540.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People\222s health, personal and social care needs are met. The home has\ a plan of care )Tj 1 0 0 1 35.5 685.57001 Tm (that the person, or someone close to them, has been involved in making. \ If they take )Tj 1 0 0 1 35.5 668.57001 Tm (medicine, they manage it themselves if they can. If they cannot manage t\ heir )Tj 1 0 0 1 35.5 651.57001 Tm (medicine, the care home supports them with it, in a safe way. People\222\ s right to privacy )Tj 1 0 0 1 35.5 634.57001 Tm (is respected and the support they get from staff is given in a way that \ maintains their )Tj 1 0 0 1 35.5 617.57001 Tm (dignity.)Tj 1 0 0 1 35.5 598.32001 Tm (If people are approaching the end of their life, the care home will resp\ ect their choices )Tj 1 0 0 1 35.5 581.32001 Tm (and help them feel comfortable and secure. They, and people close to the\ m, are )Tj 1 0 0 1 35.5 564.32001 Tm (reassured that their death will be handled with sensitivity, dignity and\ respect, and )Tj 1 0 0 1 35.5 547.32001 Tm (take account of their spiritual and cultural wishes. )Tj /C2_0 12 Tf 1 0 0 1 28.35001 523 Tm <0003>Tj 1 0 0 1 28.35001 501 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 501 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 478.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 246.81998 w 34.60001 350.75998 m 562.53998 350.75998 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 224.33 w 33.47 339.50998 m 563.65997 339.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 452.80002 m 565.87 452.80002 l S 32.35001 453.88 m 32.35001 225.14998 l S 564.78998 453.88 m 564.78998 225.14998 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 226.23 m 565.87 226.23 l S BT /T1_0 12 Tf 1 0 0 1 35.5 461.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 437.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 437.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 419.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 392.75 Tm (People are not involved in their plan of care or supported or encouraged\ to make )Tj 1 0 0 1 36.62 375.25 Tm (decisions as part of an independent lifestyle.)Tj 1 0 0 1 36.62 357.75998 Tm (\240)Tj 1 0 0 1 36.62 340.25998 Tm (People's care needs have not been reviewed monthly or as their needs cha\ nge )Tj 1 0 0 1 36.62 322.76999 Tm (meaning that people are not getting appropriate care. Staff do not alway\ s meet the )Tj 1 0 0 1 36.62 305.26999 Tm (needs of the people living at the home.)Tj 1 0 0 1 36.62 287.76999 Tm (\240)Tj 1 0 0 1 36.62 270.28 Tm (There are improvements needed to the way that medicines are handled and \ managed )Tj 1 0 0 1 36.62 252.78 Tm (in the home, to make sure that people always receive their medicines saf\ ely as their )Tj 1 0 0 1 36.62 235.28998 Tm (doctor has prescribed for them.)Tj 1 0 0 1 28.35001 210.53998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 118.33 w 34.60001 141.19 m 562.53998 141.19 l S 1 1 1 RG 22.5 w 32.35001 191.36 m 564.78998 191.36 l S 96.96001 w 33.47 129.37999 m 563.65997 129.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 178.98 m 565.87 178.98 l S 32.35001 180.06 m 32.35001 78.70001 l S 564.78998 180.06 m 564.78998 78.70001 l S 32.35001 178.98 m 564.78998 178.98 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 188.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 163.3 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. One )Tj 1 0 0 1 36.57001 145.8 Tm (person was on a temporary placement. People are accepted via the Rapid )Tj 1 0 0 1 36.57001 128.31 Tm (Intervention, Treatment and Assessment \(R.I.T.A.\) scheme when there ar\ e vacancies. )Tj 1 0 0 1 36.57001 110.81 Tm (Also people come for respite stays.)Tj 1 0 0 1 36.57001 93.31 Tm (\240)Tj ET endstream endobj 1989 0 obj 5363 endobj 1990 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (15)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Observation of the people living at the Manor House and care staff inter\ actions )Tj 1 0 0 1 34.32001 761.60004 Tm (throughout this visit found that the staff had routines that did not all\ ow for choice and )Tj 1 0 0 1 34.32001 744.10999 Tm (showed an institutional approach to caring for people. Care staff referr\ ed to people )Tj 1 0 0 1 34.32001 726.60999 Tm (who needed assistance with eating as "feeders". We heard staff talk abou\ t routines in )Tj 1 0 0 1 34.32001 709.10999 Tm (general which suggests that the home uses a task based ethos instead of \ person )Tj 1 0 0 1 34.32001 691.62 Tm (centred care which looks at the individual's need.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We looked at three care files. Only one had a plan of care and this was \ basic. The care )Tj 1 0 0 1 34.32001 639.13 Tm (plan gave information about the person's GP, their next of kin and famil\ y contact )Tj 1 0 0 1 34.32001 621.63 Tm (numbers. The reason for their admission however was not clear. There was\ minimal )Tj 1 0 0 1 34.32001 604.14001 Tm (past medical history recorded. A risk assessment had been completed for \ pressure )Tj 1 0 0 1 34.32001 586.64001 Tm (sore risk and this was rated as "high risk". This risk assessment was da\ ted 08/08/07. )Tj 1 0 0 1 34.32001 569.14996 Tm (There was no evidence to show it had been reviewed since. There was a re\ cord of )Tj 1 0 0 1 34.32001 551.64996 Tm (weight on admission to the home however there was no information about t\ he )Tj 1 0 0 1 34.32001 534.14996 Tm (person's nutritional needs or evidence to show that weight was being mon\ itored. The )Tj 1 0 0 1 34.32001 516.65997 Tm (assessment did not identify if the person was at risk in any way \(e.g. \ falling, )Tj 1 0 0 1 34.32001 499.16 Tm (malnutrition\), and the care plan did not give care staff information to\ guide them )Tj 1 0 0 1 34.32001 481.66998 Tm (about how a person's care should be delivered. The person's care plan di\ d not include )Tj 1 0 0 1 34.32001 464.16998 Tm (a psychological needs care plan. The person did not have a social care p\ lan provided )Tj 1 0 0 1 34.32001 446.66998 Tm (which would have given staff information about the person's interests an\ d what they )Tj 1 0 0 1 34.32001 429.17999 Tm (enjoyed doing. A life history was not completed, which would have given \ staff an )Tj 1 0 0 1 34.32001 411.67999 Tm (insight into the character and lifestyle of the person.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (Another person only had the pre-assessment form completed. There was a n\ ote that )Tj 1 0 0 1 34.32001 359.19 Tm (the person required bed rails however there was no risk assessment to su\ pport this. )Tj 1 0 0 1 34.32001 341.70001 Tm (When we asked the person in charge of the home, we were told that bed ra\ ils had )Tj 1 0 0 1 34.32001 324.20001 Tm (been discussed prior to the person coming into the home however they not\ been )Tj 1 0 0 1 34.32001 306.70999 Tm (provided. There was no written information to explain this decision. Als\ o the )Tj 1 0 0 1 34.32001 289.20999 Tm (assessment stated the person's gender preference of any carer giving per\ sonal care. )Tj 1 0 0 1 34.32001 271.70999 Tm (We asked the person in charge of the home if this preference could be me\ t. We were )Tj 1 0 0 1 34.32001 254.22 Tm (told no. There was no written information explaining how this preference\ was being )Tj 1 0 0 1 34.32001 236.72 Tm (managed.)Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (Daily records for all the residents gave minimal information such as "Al\ l care met". )Tj 1 0 0 1 34.32001 184.23 Tm (There were inconsistencies in recording. For example, some were complete\ d daily )Tj 1 0 0 1 34.32001 166.73999 Tm (varying up to four days. We discussed this with the person in charge of \ the home. She )Tj 1 0 0 1 34.32001 149.23999 Tm (explained that she had introduced one file that kept all the daily recor\ ds together. This )Tj 1 0 0 1 34.32001 131.75 Tm (meant that the care staff only had one place to record information. Prev\ iously each )Tj 1 0 0 1 34.32001 114.25 Tm (daily record was kept in individual files so care staff had tended to ov\ erlook writing )Tj 1 0 0 1 34.32001 96.75 Tm (daily records. She was aware that care staff needed to have training abo\ ut writing )Tj ET endstream endobj 1991 0 obj 5105 endobj 1992 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (16)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (care plans and recording information so it was informative and person ce\ ntred.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at arrangements for storing and giving medicines in the home. \ We checked )Tj 1 0 0 1 34.32001 726.60999 Tm (the records that are held in the home for medicines given to people, and\ discussed )Tj 1 0 0 1 34.32001 709.10999 Tm (how medicines are handled with the manager and other staff working in th\ e home. We )Tj 1 0 0 1 34.32001 691.62 Tm (watched some medicines being given to people in the home and saw that th\ ey are )Tj 1 0 0 1 34.32001 674.12 Tm (given using a safe method.)Tj 1 0 0 1 34.32001 656.63 Tm (\240)Tj 1 0 0 1 34.32001 639.13 Tm (Records are kept of medicines received into the home, those given to peo\ ple, and any )Tj 1 0 0 1 34.32001 621.63 Tm (unwanted medicines that are sent for destruction. All of these records h\ elp to show )Tj 1 0 0 1 34.32001 604.14001 Tm (that people are given their medicines as their doctor has prescribed for\ them.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (Most medicines charts are printed by the supplying pharmacy but sometime\ s these )Tj 1 0 0 1 34.32001 551.64996 Tm (need to be handwritten by the home. During our visit we recommended that\ two )Tj 1 0 0 1 34.32001 534.14996 Tm (members of staff check these charts and sign them, to reduce the risks o\ f any errors )Tj 1 0 0 1 34.32001 516.65997 Tm (occurring. We recommended having a list of staff signatures, to be able \ to check who )Tj 1 0 0 1 34.32001 499.16 Tm (has administered medicines to people. We also recommended that for medic\ ines )Tj 1 0 0 1 34.32001 481.66998 Tm (where doses are frequently changed, for example after blood tests, that \ the surgery or )Tj 1 0 0 1 34.32001 464.16998 Tm (clinic are asked to send or fax any changes in writing. This is to reduc\ e the risks of )Tj 1 0 0 1 34.32001 446.66998 Tm (errors occurring when telephone messages are taken.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We were shown a list of staff in the home who are authorised to give med\ icines to )Tj 1 0 0 1 34.32001 394.19 Tm (people. These staff have all had recent training, and have been assessed\ as )Tj 1 0 0 1 34.32001 376.69 Tm (competent by the person in charge.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (There are some issues with regards to storage arrangements for medicines\ in the )Tj 1 0 0 1 34.32001 324.20001 Tm (home. The home has a lockable trolley but the chain which attaches it to\ the wall is )Tj 1 0 0 1 34.32001 306.70999 Tm (broken. Controlled drugs are stored in a locked tin inside a cupboard, b\ ut they should )Tj 1 0 0 1 34.32001 289.20999 Tm (be stored in a cabinet that meets the Misuse of Drugs \(safe storage\) r\ egulations. )Tj 1 0 0 1 34.32001 271.70999 Tm (There is a separate refrigerator for medicines that require cold storage\ , but the )Tj 1 0 0 1 34.32001 254.22 Tm (temperatures in this refrigerator are not monitored. This means it is no\ t possible to be )Tj 1 0 0 1 34.32001 236.72 Tm (sure that these medicines have been stored at the correct temperatures a\ nd are safe )Tj 1 0 0 1 34.32001 219.23 Tm (to use for people. We were told by the person in charge that a new contr\ olled drugs )Tj 1 0 0 1 34.32001 201.73 Tm (cabinet, trolley and medicines refrigerator have been ordered. It is a r\ equirement that )Tj 1 0 0 1 34.32001 184.23 Tm (these storage issues are addressed, to comply with current legislation, \ and to make )Tj 1 0 0 1 34.32001 166.73999 Tm (sure medicines are stored securely for the protection of people in the h\ ome.)Tj 1 0 0 1 34.32001 149.23999 Tm (\240)Tj 1 0 0 1 34.32001 131.75 Tm (We looked at some care plans to see what information was recorded about \ people's )Tj 1 0 0 1 34.32001 114.25 Tm (medicines. We found that not much information is recorded in the plans w\ e saw. One )Tj 1 0 0 1 34.32001 96.75 Tm (person who looks after some of their own medicines had this recorded in \ the care plan )Tj ET endstream endobj 1993 0 obj 1350 endobj 1994 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (17)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (but there is no risk assessment. The home has a medicines policy which s\ ays that )Tj 1 0 0 1 34.32001 761.60004 Tm (people who do this should have signed documentation in their care plan. \ This would )Tj 1 0 0 1 34.32001 744.10999 Tm (show that it is safe for people to look after their medicines.)Tj ET endstream endobj 1995 0 obj 5799 endobj 1996 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (18)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Daily life and social activities )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 138.25 w 32.32001 644.38 m 562.52997 644.38 l S 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.64996 655.13 l S 1 1 1 RG 17 w 31.2 584.88 m 563.64996 584.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 594.5 m 565.84998 594.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 594.5 m 565.84998 594.5 l S 28.99001 575.25 m 565.84998 575.25 l S 30.07001 716.82996 m 30.07001 574.16998 l S 564.77997 716.82996 m 564.77997 574.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (Each person is treated as an individual and the care home is responsive \ to his or her )Tj 1 0 0 1 35.5 685.57001 Tm (race, culture, religion, age, disability, gender and sexual orientation.\ They are part of )Tj 1 0 0 1 35.5 668.57001 Tm (their local community. The care home supports people to follow personal \ interests and )Tj 1 0 0 1 35.5 651.57001 Tm (activities. People are able to keep in touch with family, friends and re\ presentatives. )Tj 1 0 0 1 35.5 634.57001 Tm (They are as independent as they can be, lead their chosen lifestyle and \ have the )Tj 1 0 0 1 35.5 617.57001 Tm (opportunity to make the most of their abilities. People have nutritious \ and attractive )Tj 1 0 0 1 35.5 600.57001 Tm (meals and snacks, at a time and place to suit them.)Tj 1 0 0 1 35.5 581.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 557 Tm <0003>Tj 1 0 0 1 28.35001 535 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 535 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 512.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 176.84 w 34.60001 419.75 m 562.53998 419.75 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 154.34 w 33.47 408.50998 m 563.65997 408.50998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 486.80002 m 565.87 486.80002 l S 32.35001 487.87988 m 32.35001 329.13 l S 564.78998 487.87988 m 564.78998 329.13 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 330.20999 m 565.87 330.20999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 495.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 471.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 471.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 453.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 426.75 Tm (Routines within the home often mean that people do not have a choice and\ control)Tj 1 0 0 1 36.62 409.25 Tm (over their lives.)Tj 1 0 0 1 36.62 391.75998 Tm (Improvements are needed to ensure that all people have access to varied \ and)Tj 1 0 0 1 36.62 374.25998 Tm (appropriate activities.)Tj 1 0 0 1 36.62 356.76999 Tm (People who use the service are provided with a wholesome appetising diet\ however)Tj 1 0 0 1 36.62 339.26999 Tm (improvements are needed to the way this is sometimes presented.)Tj 1 0 0 1 28.35001 314.51999 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 222.31 w 34.60001 193.17999 m 562.53998 193.17999 l S 1 1 1 RG 22.5 w 32.35001 295.34 m 564.78998 295.34 l S 200.94 w 33.47 181.37 m 563.65997 181.37 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 282.97 m 565.87 282.97 l S 32.35001 284.04001 m 32.35001 78.70001 l S 564.78998 284.04001 m 564.78998 78.70001 l S 32.35001 282.97 m 564.78998 282.97 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 292.03 Tm (Evidence:)Tj 1 0 0 1 36.57001 267.28 Tm (During our visit we saw people in their bedrooms or sitting in the main \ lounge. At )Tj 1 0 0 1 36.57001 249.78998 Tm (lunchtime most people were in the main dining room. Two people eat their\ meals at a )Tj 1 0 0 1 36.57001 232.28998 Tm (dining table in a smaller lounge. The staff interactions we observed wit\ h the people )Tj 1 0 0 1 36.57001 214.78998 Tm (who use this service were assisting people with tasks such as personal c\ are, guiding )Tj 1 0 0 1 36.57001 197.3 Tm (them to the dining room, and serving meals. During our visit two Christm\ as trees )Tj 1 0 0 1 36.57001 179.8 Tm (were put up, one in the conservatory \(that we told by staff no-one uses\ \), and one in )Tj 1 0 0 1 36.57001 162.31 Tm (the main lounge. This was done without any engagement or involvement of \ the people )Tj 1 0 0 1 36.57001 144.81 Tm (living in the home. The tree in the main lounge was later moved by the p\ erson in )Tj 1 0 0 1 36.57001 127.31 Tm (charge of the home because it was placed in a position that took no acco\ unt of people )Tj 1 0 0 1 36.57001 109.82001 Tm (sitting in the room.)Tj 1 0 0 1 36.57001 92.32001 Tm (\240)Tj ET endstream endobj 1997 0 obj 5325 endobj 1998 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (19)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (We asked the person in charge of the home about the Christmas programme.\ There )Tj 1 0 0 1 34.32001 761.60004 Tm (were no posters or other information around the home to tell people abou\ t )Tj 1 0 0 1 34.32001 744.10999 Tm (forthcoming events. We were told that a pantomime production and a Chris\ tmas party )Tj 1 0 0 1 34.32001 726.60999 Tm (were booked for the week before Christmas. We were also shown posters ab\ out the )Tj 1 0 0 1 34.32001 709.10999 Tm (pantomime that had arrived the day of our visit.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (We asked about activities and general involvement of the people who live\ in the home. )Tj 1 0 0 1 34.32001 656.63 Tm (The person in charge of the home told us that she would like to introduc\ e either an )Tj 1 0 0 1 34.32001 639.13 Tm (Activities Co-ordinator or a dedicated shift for care staff to solely pl\ an and organise )Tj 1 0 0 1 34.32001 621.63 Tm (activities for the people living in the home. We discussed the staffing \ numbers on each )Tj 1 0 0 1 34.32001 604.14001 Tm (shift and how this would impact on the care staff team. It was evident f\ rom the task )Tj 1 0 0 1 34.32001 586.64001 Tm (focused way in which staff worked that they were not used to engaging in\ a social )Tj 1 0 0 1 34.32001 569.14996 Tm (manner with the people for whom they were caring. The person in charge s\ uggested )Tj 1 0 0 1 34.32001 551.64996 Tm (that staffing numbers needed to being increased, introducing different j\ ob )Tj 1 0 0 1 34.32001 534.14996 Tm (descriptions. This would enable care staff to have time to work alongsid\ e people )Tj 1 0 0 1 34.32001 516.65997 Tm (encouraging and enabling them with daily live skills such as washing, dr\ essing and )Tj 1 0 0 1 34.32001 499.16 Tm (eating. Also they would have the time to sit and chat with people living\ in the home, )Tj 1 0 0 1 34.32001 481.66998 Tm (and become more involved rather than "looking after" people.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We spoke to one of the two cooks who works four days a week from 08:00 u\ ntil )Tj 1 0 0 1 34.32001 429.17999 Tm (14:00. We were told that the home has a four week rolling menu however t\ his needs )Tj 1 0 0 1 34.32001 411.67999 Tm (revising and updating to include a choice of main courses at lunch time.\ It was also )Tj 1 0 0 1 34.32001 394.19 Tm (hoped that the new menus would be displayed on dining room tables with a\ copy on )Tj 1 0 0 1 34.32001 376.69 Tm (display in the entrance hall so that families could see what was being s\ erved each day. )Tj 1 0 0 1 34.32001 359.19 Tm (At the time of this visit a roast meal was served two days each week and\ one day was )Tj 1 0 0 1 34.32001 341.70001 Tm (popular because it was a "fry up" day. Fridays was traditionally a fish \ meal. Salads, )Tj 1 0 0 1 34.32001 324.20001 Tm (omelets, soup and sandwiches were offered daily as an alternative to the\ main dish. )Tj 1 0 0 1 34.32001 306.70999 Tm (All the food is ordered by the cook and locally sourced as much as possi\ ble. The cook )Tj 1 0 0 1 34.32001 289.20999 Tm (told us that all the meat, fruit and vegetables were bought fresh.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (At the time of this visit two people had diabetes and the cook was able \ to prepare )Tj 1 0 0 1 34.32001 236.72 Tm (suitable foods for them to eat. She also had new menus that would includ\ e fortified )Tj 1 0 0 1 34.32001 219.23 Tm (and build-up foods for people who had low weight or were identified as b\ eing at risk of )Tj 1 0 0 1 34.32001 201.73 Tm (malnutrition. The person in charge of the home told us that when she fir\ st started )Tj 1 0 0 1 34.32001 184.23 Tm (work at the Manor House, pureed food was served mixed together by some s\ taff. Also )Tj 1 0 0 1 34.32001 166.73999 Tm (there were discrepancies about 'soft' food and 'pureed' food as the 'pur\ eed' food had )Tj 1 0 0 1 34.32001 149.23999 Tm (large pieces of meat and vegetables and was not fully blended.)Tj 1 0 0 1 34.32001 131.75 Tm (\240)Tj 1 0 0 1 34.32001 114.25 Tm (We found that pureed foods were served separately. The cook told us she \ was hoping )Tj 1 0 0 1 34.32001 96.75 Tm (to introduce food moulds so the pureed foods looked more presentable. Th\ e cook also )Tj ET endstream endobj 1999 0 obj 4303 endobj 2000 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (20)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 563.75 w 34.60001 529.52997 m 562.53998 529.52997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 542.38 w 33.47 517.71997 m 563.65997 517.71997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 244.33 l S 564.78998 791.10999 m 564.78998 244.33 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 245.40999 m 565.87 245.40999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (told us that she was hoping to attend some training courses about differ\ ent diets )Tj 1 0 0 1 34.32001 761.60004 Tm (including managing malnutrition and menu planning.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (People choose where they eat their meals. Staff told us that six people \ choose to eat )Tj 1 0 0 1 34.32001 709.10999 Tm (their lunch in their bedrooms. We met two people who were eating in the \ small )Tj 1 0 0 1 34.32001 691.62 Tm (lounge. There was a bag with some grapes in it on this table. We asked i\ f the person )Tj 1 0 0 1 34.32001 674.12 Tm (had brought them to lunch. We were told that there should have been a bo\ wl of fresh )Tj 1 0 0 1 34.32001 656.63 Tm (fruit on each dining table. It was not clear why the fruit was put on th\ e table with the )Tj 1 0 0 1 34.32001 639.13 Tm (main course.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Our observation of the dining room and smaller lounge was two very quiet\ rooms. )Tj 1 0 0 1 34.32001 586.64001 Tm (There was little interaction of any sort except between staff. Lunchtime\ was short with )Tj 1 0 0 1 34.32001 569.14996 Tm (food being served and cleared away in such a manner it did not encourage\ the meal to )Tj 1 0 0 1 34.32001 551.64996 Tm (be a social or pleasurable occasion. One person we noticed was sitting w\ ith their food )Tj 1 0 0 1 34.32001 534.14996 Tm (unsupervised and not eating. This was addressed by the person in charge \ who spoke )Tj 1 0 0 1 34.32001 516.65997 Tm (quietly and encouragingly to the person. We were told that at least six \ people eat their )Tj 1 0 0 1 34.32001 499.16 Tm (lunch in their bedrooms. There were two people eating in the smaller lou\ nge. This was )Tj 1 0 0 1 34.32001 481.66998 Tm (a matter of concern as we had earlier been told that people who needed a\ ssistance to )Tj 1 0 0 1 34.32001 464.16998 Tm (eat were not receiving help from the care staff. Many of the people livi\ ng at the Manor )Tj 1 0 0 1 34.32001 446.66998 Tm (House have a degree of confusion and/or memory loss. This means they may\ not )Tj 1 0 0 1 34.32001 429.17999 Tm (understand that the plate in front of them is food they can eat or they \ may have )Tj 1 0 0 1 34.32001 411.67999 Tm (forgotten how to eat. For others, difficulties with finger and hand join\ ts may restrict )Tj 1 0 0 1 34.32001 394.19 Tm (them in the use of cutlery. We saw no provision of plates with guards th\ at would allow )Tj 1 0 0 1 34.32001 376.69 Tm (the person to eat independently and not feel embarrassed about food fall\ ing off the )Tj 1 0 0 1 34.32001 359.19 Tm (plate. We saw no provision of ergonomic cutlery designed to enhance peop\ le's )Tj 1 0 0 1 34.32001 341.70001 Tm (experience of eating because they can hold it more easily. We did not se\ e any of the )Tj 1 0 0 1 34.32001 324.20001 Tm (care staff assisting people with eating although we did hear staff refer\ to "feeders". )Tj 1 0 0 1 34.32001 306.70999 Tm (The person in charge told us she has been trying to raise awareness with\ the care )Tj 1 0 0 1 34.32001 289.20999 Tm (staff about some people's needs with assistance and/or encouragement wit\ h eating )Tj 1 0 0 1 34.32001 271.70999 Tm (and drinking.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj ET endstream endobj 2001 0 obj 5693 endobj 2002 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (21)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Complaints and protection )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 87.25 w 32.32001 669.88 m 562.52997 669.88 l S 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.64996 680.63 l S 1 1 1 RG 17 w 31.2 635.88 m 563.64996 635.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 645.5 m 565.84998 645.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 645.5 m 565.84998 645.5 l S 28.99001 626.25 m 565.84998 626.25 l S 30.07001 716.82996 m 30.07001 625.16998 l S 564.77997 716.82996 m 564.77997 625.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (If people have concerns with their care, they or people close to them kn\ ow how to )Tj 1 0 0 1 35.5 685.57001 Tm (complain. Any concern is looked into and action taken to put things righ\ t. The care )Tj 1 0 0 1 35.5 668.57001 Tm (home safeguards people from abuse and neglect and takes action to follow\ up any )Tj 1 0 0 1 35.5 651.57001 Tm (allegations.)Tj 1 0 0 1 35.5 632.32001 Tm (People\222s legal rights are protected, including being able to vote in \ elections.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 608 Tm <0003>Tj 1 0 0 1 28.35001 586 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 586 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 563.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 211.83 w 34.60001 453.25998 m 562.53998 453.25998 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 189.33 w 33.47 442.00998 m 563.65997 442.00998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 537.79999 m 565.87 537.79999 l S 32.35001 538.88 m 32.35001 345.13998 l S 564.78998 538.88 m 564.78998 345.13998 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 346.22 m 565.87 346.22 l S BT /T1_0 12 Tf 1 0 0 1 35.5 546.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 522.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 522.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 504.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 477.75 Tm (People who use the service can be confident that complaints will be deal\ t with )Tj 1 0 0 1 36.62 460.25 Tm (appropriately.)Tj 1 0 0 1 36.62 442.75998 Tm (\240)Tj 1 0 0 1 36.62 425.25998 Tm (The lack of staff training and staff knowledge regarding protection of v\ ulnerable adults )Tj 1 0 0 1 36.62 407.76999 Tm (and restraint has the potential to put people at risk.)Tj 1 0 0 1 36.62 390.26999 Tm (\240)Tj 1 0 0 1 36.62 372.76999 Tm (Changes are needed in work practices to show that care is person centred\ and not)Tj 1 0 0 1 36.62 355.28 Tm (institutional.)Tj 1 0 0 1 28.35001 330.53 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.31998 w 34.60001 201.19 m 562.53998 201.19 l S 1 1 1 RG 22.5 w 32.35001 311.35001 m 564.78998 311.35001 l S 216.95 w 33.47 189.37999 m 563.65997 189.37999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 298.97998 m 565.87 298.97998 l S 32.35001 300.04999 m 32.35001 78.70001 l S 564.78998 300.04999 m 564.78998 78.70001 l S 32.35001 298.97998 m 564.78998 298.97998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.03998 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.29001 Tm (The Manor House has a complaints procedure however it is not evident or \ easy to read )Tj 1 0 0 1 36.57001 265.79001 Tm (because it is displayed in a hallway at an overhead height. The complain\ ts procedure )Tj 1 0 0 1 36.57001 248.3 Tm (needed to be updated to show people clearly how they can contact CQC. We\ )Tj 1 0 0 1 36.57001 230.8 Tm (suggested to the Responsible Individual and the person in charge that it\ would be )Tj 1 0 0 1 36.57001 213.31 Tm (beneficial if this document was displayed in a more prominent place, and\ at eye level.)Tj 1 0 0 1 36.57001 195.81 Tm (\240)Tj 1 0 0 1 36.57001 178.31 Tm (Observation of the staff interactions during this visit found they were \ providing care )Tj 1 0 0 1 36.57001 160.81999 Tm (and support for the people living at the home. This was task focused wit\ h little )Tj 1 0 0 1 36.57001 143.31999 Tm (involvement or interaction with the residents as individual people. A re\ cent audit of )Tj 1 0 0 1 36.57001 125.83 Tm (training needs for all the staff has found that training about protectin\ g vulnerable )Tj 1 0 0 1 36.57001 108.33 Tm (adults; dementia care; and dignity and equality are all a priority. Six \ staff were )Tj 1 0 0 1 36.57001 90.83 Tm (expected to attend a protecting vulnerable adults training course a week\ after this )Tj ET endstream endobj 2003 0 obj 1319 endobj 2004 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (22)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 73.86 w 34.60001 774.46997 m 562.53998 774.46997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 52.49001 w 33.47 762.65997 m 563.65997 762.65997 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 734.21997 l S 564.78998 791.10999 m 564.78998 734.21997 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 735.28998 m 565.87 735.28998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (inspection. Funding was expected to be made available in January 2010 fo\ r staff to )Tj 1 0 0 1 34.32001 761.60004 Tm (commence distance training about caring for people with a dementia that \ would also )Tj 1 0 0 1 34.32001 744.10999 Tm (include dignity and equality.)Tj ET endstream endobj 2005 0 obj 5584 endobj 2006 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (23)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 229.33 w 34.60001 427.50998 m 562.53998 427.50998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 206.83 w 33.47 416.25998 m 563.65997 416.25998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 310.63998 l S 564.78998 521.88 m 564.78998 310.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 311.72 m 565.87 311.72 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Generally individual bedrooms appeared homely.)Tj 1 0 0 1 36.62 443.25 Tm (\240)Tj 1 0 0 1 36.62 425.75998 Tm (The accommodation and grounds are spacious, but some areas are tired and\ in need )Tj 1 0 0 1 36.62 408.25998 Tm (of refurbishment)Tj 1 0 0 1 36.62 390.76999 Tm (\240)Tj 1 0 0 1 36.62 373.26999 Tm (The storage of equipment, oddments of furniture and general supplies in \ lounges and )Tj 1 0 0 1 36.62 355.76999 Tm (bathrooms made the home feel cluttered and uncared for.)Tj 1 0 0 1 36.62 338.28 Tm (\240)Tj 1 0 0 1 36.62 320.78 Tm (Carpets throughout the home are in need of replacement.)Tj 1 0 0 1 28.35001 296.04001 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 203.81999 w 34.60001 183.94 m 562.53998 183.94 l S 1 1 1 RG 22.5 w 32.35001 276.85001 m 564.78998 276.85001 l S 182.45 w 33.47 172.12999 m 563.65997 172.12999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 264.47998 m 565.87 264.47998 l S 32.35001 265.56 m 32.35001 78.70001 l S 564.78998 265.56 m 564.78998 78.70001 l S 32.35001 264.47998 m 564.78998 264.47998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 273.54001 Tm (Evidence:)Tj 1 0 0 1 36.57001 248.78998 Tm (The Manor House is a detached two-storey house with a two-storey extensi\ on and has )Tj 1 0 0 1 36.57001 231.3 Tm (been modified with ramps and a shaft lift. There are twenty-eight single\ bedrooms, )Tj 1 0 0 1 36.57001 213.8 Tm (sixteen on the ground floor and twelve on the first floor. There is one \ shared room on )Tj 1 0 0 1 36.57001 196.31 Tm (the first floor. Seventeen bedrooms have en-suite toilets. There are two\ call bell )Tj 1 0 0 1 36.57001 178.81 Tm (systems fitted in the home. One system is no longer in use however it ha\ s not been )Tj 1 0 0 1 36.57001 161.31 Tm (removed. The newer system enables the bell cords to reach anywhere in th\ e bedroom. )Tj 1 0 0 1 36.57001 143.81999 Tm (We found that the staff have to be reminded to be pro-active about ensur\ ing people )Tj 1 0 0 1 36.57001 126.32001 Tm (can reach their bell. All the bedrooms we saw were personalised and indi\ vidual.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (Bathing, showering and toilet facilities are available on each floor, cl\ ose to bedrooms )Tj ET endstream endobj 2007 0 obj 5389 endobj 2008 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (24)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (and communal rooms. These are domestic in style. Only one has equipment \ to assist )Tj 1 0 0 1 34.32001 761.60004 Tm (bathing. We found these bathrooms were cluttered and were more use as st\ orage )Tj 1 0 0 1 34.32001 744.10999 Tm (areas than as a pleasant facility that people may enjoy using. There wer\ e also )Tj 1 0 0 1 34.32001 726.60999 Tm (toiletries that we suspected were used by the staff for everyone rather \ than people )Tj 1 0 0 1 34.32001 709.10999 Tm (using their personal toiletries. We were told about plans to convert one\ of the )Tj 1 0 0 1 34.32001 691.62 Tm (bathrooms into a wet room because it is too small.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (There are a lounge, a dining rooms as well as a smaller lounge with a di\ ning table on )Tj 1 0 0 1 34.32001 639.13 Tm (the ground floor. The dining chairs do not have arm rests. This makes it\ difficult for )Tj 1 0 0 1 34.32001 621.63 Tm (people to sit down or stand up from the chair without supplementary supp\ ort such as )Tj 1 0 0 1 34.32001 604.14001 Tm (the dining table. It also makes it more difficult for people to move the\ ir chair nearer or )Tj 1 0 0 1 34.32001 586.64001 Tm (further away from the table.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (As we toured the premises the home appeared cluttered and uncared for. P\ ieces of )Tj 1 0 0 1 34.32001 534.14996 Tm (furniture, for example, left by previous residents, had been moved out o\ f bedrooms )Tj 1 0 0 1 34.32001 516.65997 Tm (then left. The linen rooms had clean bedding on the floor where it had n\ ot been )Tj 1 0 0 1 34.32001 499.16 Tm (properly folded and placed on the shelf. Other bedding was jumbled and l\ ooked like it )Tj 1 0 0 1 34.32001 481.66998 Tm (had been thrown into the cupboard without any care for where it landed. \ The main )Tj 1 0 0 1 34.32001 464.16998 Tm (linen room itself was not clean with sweet wrappers on the floor and dus\ t balls )Tj 1 0 0 1 34.32001 446.66998 Tm (gathering around the skirting boards and behind the door. The laundry ha\ d a large )Tj 1 0 0 1 34.32001 429.17999 Tm (shelving area covered by a curtain. Again it was cluttered with all sort\ s of items )Tj 1 0 0 1 34.32001 411.67999 Tm (pushed in anywhere. Fire door signs were peeling and fraying at the edge\ s. Paint was )Tj 1 0 0 1 34.32001 394.19 Tm (chipped on skirting boards and doors. One bedroom door had a hole in it \ where the )Tj 1 0 0 1 34.32001 376.69 Tm (en-suite door handle knocked into it each time it was opened. The carpet\ s look tired )Tj 1 0 0 1 34.32001 359.19 Tm (and in places are worn with tape stuck to hold the carpet together prese\ nting a trip )Tj 1 0 0 1 34.32001 341.70001 Tm (hazard. The floor of the care home is uneven in places with small slopes\ that are not )Tj 1 0 0 1 34.32001 324.20001 Tm (readily visible due to the pattern of the carpet. These also present tri\ p hazards. The )Tj 1 0 0 1 34.32001 306.70999 Tm (front garden is overgrown with weeds and dead plants. There were many se\ emingly )Tj 1 0 0 1 34.32001 289.20999 Tm (insignificant areas that needed attention. These overall created a home \ that looks )Tj 1 0 0 1 34.32001 271.70999 Tm (shabby and tired that no-one respects or cares about.)Tj 1 0 0 1 34.32001 254.22 Tm (\240)Tj 1 0 0 1 34.32001 236.72 Tm (We discussed with the Responsible Individual our concerns that a tour of\ the premises )Tj 1 0 0 1 34.32001 219.23 Tm (inside and outside showed little evidence of routine care and management\ or respect )Tj 1 0 0 1 34.32001 201.73 Tm (for the upkeep of the home. We were told that the home employs a mainten\ ance )Tj 1 0 0 1 34.32001 184.23 Tm (person and a gardener as well as care staff. It is understood there is a\ n annual )Tj 1 0 0 1 34.32001 166.73999 Tm (environmental audit undertaken by the responsible individual. It was unc\ lear if there is )Tj 1 0 0 1 34.32001 149.23999 Tm (a plan for the ongoing regular maintenance of the home to make sure that\ the )Tj 1 0 0 1 34.32001 131.75 Tm (condition of the home does not deteriorate further. Also it was unclear \ who oversees )Tj 1 0 0 1 34.32001 114.25 Tm (the maintenance person or the gardener. It was suggested during this vis\ it that this )Tj 1 0 0 1 34.32001 96.75 Tm (should be reviewed as well as providing more structured expectations for\ all staff with )Tj ET endstream endobj 2009 0 obj 2300 endobj 2010 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (25)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 248.81998 w 34.60001 686.98999 m 562.53998 686.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 227.45 w 33.47 675.17999 m 563.65997 675.17999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 559.26001 l S 564.78998 791.10999 m 564.78998 559.26001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 560.33997 m 565.87 560.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (regard to reporting areas needing attention and designating responsibili\ ty so ensuring )Tj 1 0 0 1 34.32001 761.60004 Tm (things are done.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (Storage is an issue at the care home. For example, the larder for the ki\ tchen is on the )Tj 1 0 0 1 34.32001 709.10999 Tm (first floor. This larder is next to three bedrooms, at the end of a corr\ idor, out of sight. )Tj 1 0 0 1 34.32001 691.62 Tm (On the day of our visit the door was marked to be kept locked at all tim\ es, however )Tj 1 0 0 1 34.32001 674.12 Tm (we found it open. We were told by staff that it is not convenient when t\ hey are )Tj 1 0 0 1 34.32001 656.63 Tm (preparing food or when there is a food delivery. The person in charge ha\ s started a )Tj 1 0 0 1 34.32001 639.13 Tm (review of all the storage in the care home.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Bedrooms are redecorated when they become empty. Although curtains and b\ edding )Tj 1 0 0 1 34.32001 586.64001 Tm (are provided we were told that people can choose to bring in their own s\ oft furnishings )Tj 1 0 0 1 34.32001 569.14996 Tm (and bedding subject to fire compliance and other health and safety measu\ res.)Tj ET endstream endobj 2011 0 obj 5735 endobj 2012 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (26)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Staffing )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 17 w 31.2 618.88 m 563.64996 618.88 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have safe and appropriate support as there are enough competent s\ taff on duty )Tj 1 0 0 1 35.5 685.57001 Tm (at all times. They have confidence in the staff at the home because chec\ ks have been )Tj 1 0 0 1 35.5 668.57001 Tm (done to make sure that they are suitable to care for them. Their needs a\ re met and )Tj 1 0 0 1 35.5 651.57001 Tm (they are cared for by staff who get the relevant training and support fr\ om their )Tj 1 0 0 1 35.5 634.57001 Tm (managers.)Tj 1 0 0 1 35.5 615.32001 Tm (There are no additional outcomes.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 445.00998 m 562.53998 445.00998 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 171.84 w 33.47 433.75998 m 563.65997 433.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 345.63998 l S 564.78998 521.88 m 564.78998 345.63998 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 346.70999 m 565.87 346.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staffing levels and skill mixes on each shift need to be reviewed to ens\ ure that people )Tj 1 0 0 1 36.62 443.25 Tm (are always cared for in a safe way.)Tj 1 0 0 1 36.62 425.75998 Tm (\240)Tj 1 0 0 1 36.62 408.25998 Tm (Not all staff are adequately trained to meet the needs of the people liv\ ing at the)Tj 1 0 0 1 36.62 390.76999 Tm (home.)Tj 1 0 0 1 36.62 373.26999 Tm (Recruitment systems used at the home are not robust and have the potenti\ al to place )Tj 1 0 0 1 36.62 355.76999 Tm (people at risk.)Tj 1 0 0 1 28.35001 331.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 238.81998 w 34.60001 201.42998 m 562.53998 201.42998 l S 1 1 1 RG 22.5 w 32.35001 311.84 m 564.78998 311.84 l S 217.45 w 33.47 189.62 m 563.65997 189.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 299.47 m 565.87 299.47 l S 32.35001 300.54999 m 32.35001 78.70001 l S 564.78998 300.54999 m 564.78998 78.70001 l S 32.35001 299.47 m 564.78998 299.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 308.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 283.79001 Tm (On the day of our visit there were twenty-three people living at the Man\ or House. )Tj 1 0 0 1 536.01001 283.79001 Tm (No-)Tj 1 0 0 1 36.57001 266.29001 Tm (one)Tj 1 0 0 1 58.60001 266.29001 Tm ( was on a respite stay at this time although this is possible. The R.I.T\ .A. team also )Tj 1 0 0 1 36.57001 248.78998 Tm (make short stay placements at the Manor House when there are vacancies.)Tj 1 0 0 1 36.57001 231.3 Tm (\240)Tj 1 0 0 1 36.57001 213.8 Tm (During the morning as we walked around the building, we saw four carers,\ the cook, )Tj 1 0 0 1 36.57001 196.31 Tm (the maintenance person and the person in charge. There was also a volunt\ eer who )Tj 1 0 0 1 36.57001 178.81 Tm (was working with the maintenance person and also assisted in the kitchen\ clearing up )Tj 1 0 0 1 36.57001 161.31 Tm (after lunch. In the afternoon there were three carers and the person in \ charge. We )Tj 1 0 0 1 36.57001 143.81999 Tm (were told that two cleaners are employed to work five hours each day, Mo\ nday to )Tj 1 0 0 1 36.57001 126.32001 Tm (Friday, and one cleaner works five hours on Saturdays. The care staff ar\ e responsible )Tj 1 0 0 1 36.57001 108.83 Tm (for cleaning the home on Sundays. The care staff are also responsible fo\ r all the )Tj 1 0 0 1 36.57001 91.33 Tm (laundry. The dishevelled state of the laundry and linen cupboards showed\ no-one took )Tj ET endstream endobj 2013 0 obj 5318 endobj 2014 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (27)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (any responsibility or care about maintaining them clean and tidy. There \ are two carers )Tj 1 0 0 1 34.32001 761.60004 Tm (on duty overnight from 20:00 to 08:00.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (There were signs that staff were not providing the level of care people \ deserved. )Tj 1 0 0 1 34.32001 709.10999 Tm (People were left for long periods of time with no interaction by staff. \ During our visit )Tj 1 0 0 1 34.32001 691.62 Tm (we observed one person who stays in their room all day. The staff were s\ een giving )Tj 1 0 0 1 34.32001 674.12 Tm (medication. We saw that lunch had been taken in and later cleared away. \ We did not )Tj 1 0 0 1 34.32001 656.63 Tm (see any interaction or encouragement offered by the staff. They were foc\ used on )Tj 1 0 0 1 34.32001 639.13 Tm (achieving tasks. As we observed the staff around the home, some staff ap\ peared to )Tj 1 0 0 1 34.32001 621.63 Tm (forget that they were working with individuals in their home. One exampl\ e was during )Tj 1 0 0 1 34.32001 604.14001 Tm (the morning a few people were sitting in the lounge. A Christmas tree wa\ s being put )Tj 1 0 0 1 34.32001 586.64001 Tm (up in the conservatory \(this leads off the lounge, and later a second t\ ree was put up in )Tj 1 0 0 1 34.32001 569.14996 Tm (the lounge. The staff did not engage with or involve the people who live\ in the home )Tj 1 0 0 1 34.32001 551.64996 Tm (with this activity. One tree had to be moved because it was placed in su\ ch a way that )Tj 1 0 0 1 34.32001 534.14996 Tm (some people sitting in the room were blocked from the rest of the room b\ y the tree.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (Drinks and meal times are rushed. Care staff are taken away from their d\ uties of )Tj 1 0 0 1 34.32001 481.66998 Tm (caring for the people living in the home because they are responsible fo\ r food )Tj 1 0 0 1 34.32001 464.16998 Tm (preparation at breakfast time, teatime and supper time. The carers are p\ reparing and )Tj 1 0 0 1 34.32001 446.66998 Tm (serving food whilst they may also be assisting people with getting up or\ going to bed, )Tj 1 0 0 1 34.32001 429.17999 Tm (and giving out medication. Our observation of lunchtime found it was cha\ otic. The )Tj 1 0 0 1 34.32001 411.67999 Tm (cook is responsible for preparing, cooking and putting the food out on t\ o individual )Tj 1 0 0 1 34.32001 394.19 Tm (plates ready for the care staff to take to people. We found that because\ the larder is )Tj 1 0 0 1 34.32001 376.69 Tm (on the first floor this can mean several trips up and down stairs. This \ adds to food )Tj 1 0 0 1 34.32001 359.19 Tm (preparation times. It also increases the risk of injury or harm because \ the cook has to )Tj 1 0 0 1 34.32001 341.70001 Tm (leave the kitchen unattended as well as carry catering size food packets\ and tins from )Tj 1 0 0 1 34.32001 324.20001 Tm (the larder back to the kitchen. All the carers assisted with serving and\ clearing meals )Tj 1 0 0 1 34.32001 306.70999 Tm (at lunchtime. The kitchen was therefore dangerous at that time because a\ ll the staff )Tj 1 0 0 1 34.32001 289.20999 Tm (were in and out, at times all together.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (Our observation of care staff caused us to question if they understood w\ hen it was )Tj 1 0 0 1 34.32001 236.72 Tm (appropriate to wear gloves. One carer was wearing gloves on every occasi\ on we saw )Tj 1 0 0 1 34.32001 219.23 Tm (them: during a medication round, assisting someone with their personal h\ ygiene, )Tj 1 0 0 1 34.32001 201.73 Tm (taking a resident by the hand having just exited from a bedroom carrying\ soiled items, )Tj 1 0 0 1 34.32001 184.23 Tm (and whilst serving food.)Tj 1 0 0 1 34.32001 166.73999 Tm (\240)Tj 1 0 0 1 34.32001 149.23999 Tm (We discussed our concerns with the person in charge and the cook. Both w\ ere aware )Tj 1 0 0 1 34.32001 131.75 Tm (of the dangers and risks of staff carrying hot food and drinks as well a\ s cross infection. )Tj 1 0 0 1 34.32001 114.25 Tm (They raised their concern that the wash hand basin is on the far side of\ the kitchen. )Tj 1 0 0 1 34.32001 96.75 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj ET endstream endobj 2015 0 obj 5389 endobj 2016 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (28)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 761.60004 Tm (their visit. The person in charge told us that care staff had been told \ not to wear )Tj 1 0 0 1 34.32001 744.10999 Tm (gloves when they were preparing food as this was not necessary. One prop\ osal they )Tj 1 0 0 1 34.32001 726.60999 Tm (suggested was to serve lunch from a heated trolley in the dining room. T\ here was also )Tj 1 0 0 1 34.32001 709.10999 Tm (a proposal that a part time kitchen assistant could reduce care hours us\ ed for the )Tj 1 0 0 1 34.32001 691.62 Tm (preparation of food. This would also reduce the numbers of people who pa\ ss through )Tj 1 0 0 1 34.32001 674.12 Tm (the kitchen on a daily basis and reduce the risk of cross infection. We \ discussed this )Tj 1 0 0 1 34.32001 656.63 Tm (with the person in charge and the cook. Both were aware of the dangers a\ nd risks of )Tj 1 0 0 1 34.32001 639.13 Tm (staff carrying hot food and drinks as well as cross infection. We raised\ our concern )Tj 1 0 0 1 34.32001 621.63 Tm (about care staff understanding when it was appropriate to wear gloves. O\ ne carer was )Tj 1 0 0 1 34.32001 604.14001 Tm (wearing gloves on every occasion we saw them: during a medication round,\ assisting )Tj 1 0 0 1 34.32001 586.64001 Tm (someone with their personal hygiene, and whilst serving food. The same c\ arer was )Tj 1 0 0 1 34.32001 569.14996 Tm (also seen taking a resident by the hand having just exited from a bedroo\ m carrying )Tj 1 0 0 1 34.32001 551.64996 Tm (soiled items. They had not removed the gloves or disposed of the soiled \ items before )Tj 1 0 0 1 34.32001 534.14996 Tm (assisting the resident.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (The person in charge told us that care staff had been told not to wear g\ loves when )Tj 1 0 0 1 34.32001 481.66998 Tm (they were preparing food as this was not necessary. The cook and the per\ son in )Tj 1 0 0 1 34.32001 464.16998 Tm (charge raised their concern that the wash hand basin is on the far side \ of the kitchen. )Tj 1 0 0 1 34.32001 446.66998 Tm (This means that everyone has to walk through the kitchen in order to was\ h their )Tj 1 0 0 1 34.32001 429.17999 Tm (hands. An Environmental Health Officer identified this as a matter of co\ ncern during )Tj 1 0 0 1 34.32001 411.67999 Tm (their visit. One proposal was to serve lunch from a heated trolley in th\ e dining room. )Tj 1 0 0 1 34.32001 394.19 Tm (There was also a proposal that a part time kitchen assistant could reduc\ e care hours )Tj 1 0 0 1 34.32001 376.69 Tm (used for the preparation of food. This would also reduce the numbers of \ people who )Tj 1 0 0 1 34.32001 359.19 Tm (pass through the kitchen on a daily basis.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We looked at staff files for four staff. One of the four had a photograp\ h of the person. )Tj 1 0 0 1 34.32001 306.70999 Tm (Three had an application form. Two had two written references. One had a\ record of )Tj 1 0 0 1 34.32001 289.20999 Tm (telephone references only, and one had a personal reference. Only two ha\ d a valid )Tj 1 0 0 1 34.32001 271.70999 Tm (police check. One had a record of induction and supervision. Three had a\ contract with )Tj 1 0 0 1 34.32001 254.22 Tm (terms and conditions of employment.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (We were told that there have been two staff meetings recently to raise a\ wareness )Tj 1 0 0 1 34.32001 201.73 Tm (amongst the staff about working together as a team. We were also told th\ at future )Tj 1 0 0 1 34.32001 184.23 Tm (staff recruitment will include staff working on a rotational basis. Pres\ ent staff are )Tj 1 0 0 1 34.32001 166.73999 Tm (being encouraged to change shifts, especially between day and night shif\ ts to enhance )Tj 1 0 0 1 34.32001 149.23999 Tm (staff experience of a day and night in the life of people who live in th\ e care home. We )Tj 1 0 0 1 34.32001 131.75 Tm (suggested that a review of staffing levels at particularly peak times of\ the day \(before )Tj 1 0 0 1 34.32001 114.25 Tm (breakfast, teatime and twilight hours\) may help the staff to work in a \ way that )Tj 1 0 0 1 34.32001 96.75 Tm (engages with the people living in the home. We also suggested that incre\ asing the )Tj ET endstream endobj 2017 0 obj 2531 endobj 2018 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (29)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 283.81 w 34.60001 669.5 m 562.53998 669.5 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 262.44 w 33.47 657.69 m 563.65997 657.69 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 524.26996 l S 564.78998 791.10999 m 564.78998 524.26996 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 525.33997 m 565.87 525.33997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (staff number during the evening would give the people living in the home\ more choice )Tj 1 0 0 1 34.32001 761.60004 Tm (about what time they go to bed. Some care plans we saw had a standard co\ mment )Tj 1 0 0 1 34.32001 744.10999 Tm (about bedtimes. This inferred that people would go to bed when they were\ told to do )Tj 1 0 0 1 34.32001 726.60999 Tm (so by staff. We were unable to finding supporting evidence that people w\ ere going to )Tj 1 0 0 1 34.32001 709.10999 Tm (bed before 20:00 because this was their choice and not because it suited\ the staff )Tj 1 0 0 1 34.32001 691.62 Tm (shifts and duties.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (A staff training analysis is due to be undertaken by the person in charg\ e. Key areas of )Tj 1 0 0 1 34.32001 639.13 Tm (mandatory training have already been identified as lacking. Some local t\ raining has )Tj 1 0 0 1 34.32001 621.63 Tm (been identified and booked. The person in charge is hoping to introduce \ distance )Tj 1 0 0 1 34.32001 604.14001 Tm (learning for all staff with an option for them to study at home. She pla\ ns to set up a )Tj 1 0 0 1 34.32001 586.64001 Tm (training file that will cross reference with each staff member's personn\ el file thereby )Tj 1 0 0 1 34.32001 569.14996 Tm (providing a "quick glance" reference for each staff member. She also pla\ ns to set up a )Tj 1 0 0 1 34.32001 551.64996 Tm (NVQ matrix and a mandatory training matrix.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj ET endstream endobj 2019 0 obj 5756 endobj 2020 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (30)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 194.33 w 34.60001 360.00998 m 562.53998 360.00998 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 171.84 w 33.47 348.75998 m 563.65997 348.75998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 260.63998 l S 564.78998 436.88 m 564.78998 260.63998 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 261.70999 m 565.87 261.70999 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (Lack of effective management at the home has had a negative impact on th\ e quality )Tj 1 0 0 1 36.62 358.25 Tm (of the service provided.)Tj 1 0 0 1 36.62 340.75998 Tm (\240)Tj 1 0 0 1 36.62 323.25998 Tm (Staff have been poorly supervised at the home meaning that poor practice\ has not )Tj 1 0 0 1 36.62 305.76999 Tm (been addressed.)Tj 1 0 0 1 36.62 288.26999 Tm (\240)Tj 1 0 0 1 36.62 270.76999 Tm (People are placed at risk because of some health and safety practices at\ the home.)Tj 1 0 0 1 28.35001 246.03 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 153.81999 w 34.60001 158.92999 m 562.53998 158.92999 l S 1 1 1 RG 22.5 w 32.35001 226.84 m 564.78998 226.84 l S 132.45 w 33.47 147.12 m 563.65997 147.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 214.47 m 565.87 214.47 l S 32.35001 215.54999 m 32.35001 78.70001 l S 564.78998 215.54999 m 564.78998 78.70001 l S 32.35001 214.47 m 564.78998 214.47 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 223.53 Tm (Evidence:)Tj 1 0 0 1 36.57001 198.78998 Tm (The registered manager left the Manor House in the autumn of this year. \ Someone )Tj 1 0 0 1 36.57001 181.28998 Tm (was appointed to replace the registered manager and has been in post sin\ ce )Tj 1 0 0 1 36.57001 163.78999 Tm (November 2009. The departure of the registered manager has brought to li\ ght a )Tj 1 0 0 1 36.57001 146.3 Tm (number of serious concerns that affect the health and well being of the \ people living at )Tj 1 0 0 1 36.57001 128.8 Tm (the Manor House. These include pre- assessments of prospective residents\ ; )Tj 1 0 0 1 36.57001 111.31 Tm (comprehensive plans of care setting out in detail the action that needs \ to be taken to )Tj 1 0 0 1 36.57001 93.81 Tm (ensure that all aspects of health, personal and social care needs of eac\ h individual, )Tj ET endstream endobj 2021 0 obj 5301 endobj 2022 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (31)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (including any relevant clinical guidelines and risk assessments, are met\ ; robust )Tj 1 0 0 1 34.32001 761.60004 Tm (policies and procedures for dealing with medicines; variable routines of\ daily living and )Tj 1 0 0 1 34.32001 744.10999 Tm (activities that involve the people using this service; regard for privac\ y and dignity of )Tj 1 0 0 1 34.32001 726.60999 Tm (the people using this service; robust policies and procedures for the re\ cruitment of )Tj 1 0 0 1 34.32001 709.10999 Tm (suitable, competent and experienced staff; training for all staff to ens\ ure they are )Tj 1 0 0 1 34.32001 691.62 Tm (suitably qualified and competent to do their jobs, and that the people u\ sing this )Tj 1 0 0 1 34.32001 674.12 Tm (service are in safe hands at all times; robust policies and procedures t\ o ensure that )Tj 1 0 0 1 34.32001 656.63 Tm (the health, safety and welfare of both the people using this service and\ the staff are )Tj 1 0 0 1 34.32001 639.13 Tm (promoted and protected at all times.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (At the time of this visit the Responsible Individual acknowledged that h\ e "had taken )Tj 1 0 0 1 34.32001 586.64001 Tm (his eye off the ball" because the home was rated 'three star' at the las\ t key inspection. )Tj 1 0 0 1 34.32001 569.14996 Tm (Also he had considered the registered manager to be discharging her duti\ es fully. The )Tj 1 0 0 1 34.32001 551.64996 Tm (provider visits \(Regualtion 26 reports\), he told us, had not therefore\ been "as in depth )Tj 1 0 0 1 34.32001 534.14996 Tm (as they should have been". He agreed that with the person in day to day \ charge of the )Tj 1 0 0 1 34.32001 516.65997 Tm (home they would draw up a plan to review all aspects of care provided at\ the Manor )Tj 1 0 0 1 34.32001 499.16 Tm (House.)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (We discussed with the Responsible Individual the need for a review of st\ aff numbers )Tj 1 0 0 1 34.32001 446.66998 Tm (and skills on each shift, the duties they are expected to carrying out d\ uring their shifts )Tj 1 0 0 1 34.32001 429.17999 Tm (so they can be held accountable for their actions, the time staff are gi\ ven for these )Tj 1 0 0 1 34.32001 411.67999 Tm (tasks, and what outcomes staff provision and delegation of tasks provide\ s for the )Tj 1 0 0 1 34.32001 394.19 Tm (people who use this service. Also that staff should receive regular supe\ rvision to )Tj 1 0 0 1 34.32001 376.69 Tm (provide them with support and to review their work performance and train\ ing needs.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At the time of this visit there was little evidence of staff awareness o\ r training about )Tj 1 0 0 1 34.32001 324.20001 Tm (caring for people with a dementia. We discussed with the Responsible Ind\ ividual that )Tj 1 0 0 1 34.32001 306.70999 Tm (all the staff working at the Manor House should receive training and gui\ dance about )Tj 1 0 0 1 34.32001 289.20999 Tm (good practice in caring for people who have a dementia. The Responsible \ Individual )Tj 1 0 0 1 34.32001 271.70999 Tm (told us that the staff working in the other homes in the South West Care\ Homes' )Tj 1 0 0 1 34.32001 254.22 Tm (group have had training using an Alzheimer's Society programme called "Y\ esterday, )Tj 1 0 0 1 34.32001 236.72 Tm (today, tomorrow". This should have been implemented at the beginning of \ 2009 at the )Tj 1 0 0 1 34.32001 219.23 Tm (Manor House by the registered manager. The departure of the registered m\ anager )Tj 1 0 0 1 34.32001 201.73 Tm (brought to light this has not happened.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (We discussed the physical environment of the building with the person in\ charge. )Tj 1 0 0 1 34.32001 149.23999 Tm (There is little signage or visual aids that could assist people find the\ ir way around, )Tj 1 0 0 1 34.32001 131.75 Tm (particularly the people who have a memory loss. There are unmarked rampi\ ng along )Tj 1 0 0 1 34.32001 114.25 Tm (the landings. There are carpet strips where carpets are worn and torn. B\ oth are )Tj 1 0 0 1 34.32001 96.75 Tm (potential trip hazards. An electrical meter cupboard situated in a bathr\ oom has no )Tj ET endstream endobj 2023 0 obj 5063 endobj 2024 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (32)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (44)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 703.71997 w 34.60001 459.54999 m 562.53998 459.54999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 682.33997 w 33.47 447.73999 m 563.65997 447.73999 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 104.36 l S 564.78998 791.10999 m 564.78998 104.36 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 105.44 m 565.87 105.44 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (warning sign or lock. The busy pattern of the carpets could be very conf\ using for some )Tj 1 0 0 1 34.32001 761.60004 Tm (people who have a dementia. The building looked cluttered and uncared fo\ r generally )Tj 1 0 0 1 34.32001 744.10999 Tm (such as fire signs peeling off doors, chipped paint on skirting boards, \ and a neglected )Tj 1 0 0 1 34.32001 726.60999 Tm (front garden.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We talked to the Responsible Individual and the person in charge about t\ he furniture )Tj 1 0 0 1 34.32001 674.12 Tm (we had seen around the home. Some chairs for example, are not suitable f\ or anyone )Tj 1 0 0 1 34.32001 656.63 Tm (who is physically frail and needs assistance with sitting down and stand\ ing up. Our )Tj 1 0 0 1 34.32001 639.13 Tm (observation saw people putting themselves and others at risk in the dini\ ng room )Tj 1 0 0 1 34.32001 621.63 Tm (because they were using the dining tables as a support for this purpose.\ Similarly )Tj 1 0 0 1 34.32001 604.14001 Tm (there is a lack of equipment such as handrails in halls and landings, an\ d only one )Tj 1 0 0 1 34.32001 586.64001 Tm (bathroom had a hoist to assist people getting in and out of the bath. We\ suggested )Tj 1 0 0 1 34.32001 569.14996 Tm (that an Occupational Therapist's assessment and advice about the home an\ d external )Tj 1 0 0 1 34.32001 551.64996 Tm (grounds would provide the provider with clear indicators about how the h\ ome could be )Tj 1 0 0 1 34.32001 534.14996 Tm (as accessible as possible for the people using the service. It would als\ o enable them )Tj 1 0 0 1 34.32001 516.65997 Tm (and increase their independence.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (The person in charge told us that she was reviewing storage around the h\ ome. She )Tj 1 0 0 1 34.32001 464.16998 Tm (hoped new cupboards or alternative storage areas could be built or impro\ vised around )Tj 1 0 0 1 34.32001 446.66998 Tm (the home for the storage of medications and clean linen. We also suggest\ ed that )Tj 1 0 0 1 34.32001 429.17999 Tm (alternative arrangements to relocate the larder and store food near or i\ n the kitchen )Tj 1 0 0 1 34.32001 411.67999 Tm (would be beneficial for the safety of both staff and the people using th\ is service. This )Tj 1 0 0 1 34.32001 394.19 Tm (was in light of the larder being found open in spite of a sign stating i\ t should be kept )Tj 1 0 0 1 34.32001 376.69 Tm (locked at all times, the cook having to leave the kitchen unattended dur\ ing the )Tj 1 0 0 1 34.32001 359.19 Tm (preparation of hot food, and the moving and handling up and downstairs o\ f )Tj 1 0 0 1 34.32001 341.70001 Tm (commercial, catering size tins and other food packages.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We reminded the person in charge that doors must not be wedged open and \ that staff )Tj 1 0 0 1 34.32001 289.20999 Tm (must be made aware of this. If, as we found during our visit the linen c\ upboard is )Tj 1 0 0 1 34.32001 271.70999 Tm (wedged open because beds are being changed, the wedge must be removed as\ soon )Tj 1 0 0 1 34.32001 254.22 Tm (as no-one is using the cupboard. Alternatively any doors wedged open on \ a regular )Tj 1 0 0 1 34.32001 236.72 Tm (basis must be fitted with a suitable device that links with the home's f\ ire alarm )Tj 1 0 0 1 34.32001 219.23 Tm (system.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (We reminded the person in charge to ensure robust measures are in place \ to prevent )Tj 1 0 0 1 34.32001 166.73999 Tm (the risk of cross infection. Also where and how to record accidents, and\ securely retain )Tj 1 0 0 1 34.32001 149.23999 Tm (copies of accidents. We urged that all staff receive urgent training on \ all safe working )Tj 1 0 0 1 34.32001 131.75 Tm (practices to ensure that the health, safety and welfare of the people us\ ing this service )Tj 1 0 0 1 34.32001 114.25 Tm (are promoted and protected at all times.)Tj ET endstream endobj 2025 0 obj 3690 endobj 2026 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (33)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj ET 0.99216 0.9451 0.76077 RG 36.25 w 29.47 793.27997 m 564.96997 793.27997 l S 0.95294 0.95294 0.95294 RG 17 w 28.35001 804.02997 m 566.10004 804.02997 l S 28.35001 784.77997 m 422.10001 784.77997 l S 424.34998 784.77997 m 467.10001 784.77997 l S 1 1 1 RG 469.34998 784.77997 m 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567.32001 614.60004 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 31.2 702.45001 Tm (Outstanding statutory requirements)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 34.05 684.02997 Tm (These are requirements that were set at the previous inspection, but hav\ e still not )Tj 1 0 0 1 34.05 669.45001 Tm (been met.)Tj 1 0 0 1 95.57001 669.45001 Tm (\240 )Tj 1 0 0 1 104.02 669.45001 Tm (They say what the registered person had to do to meet the Care Standards\ )Tj 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards\ .)Tj /T1_0 10 Tf 1 0 0 1 31.2 637.04999 Tm (No.)Tj 1 0 0 1 96.10001 634.04999 Tm (Standard)Tj 1 0 0 1 202.5 634.04999 Tm (Regulation)Tj 1 0 0 1 294.60001 634.04999 Tm (Requirement)Tj 1 0 0 1 479 634.04999 Tm (Timescale for )Tj 1 0 0 1 479 621.90002 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 602.48999 Tm (\240)Tj 1 0 0 1 96.15001 599.48999 Tm (\240)Tj 1 0 0 1 202.5 599.48999 Tm (\240)Tj 1 0 0 1 294.54999 599.48999 Tm (\240)Tj 1 0 0 1 478.89993 599.48999 Tm (\240)Tj ET endstream endobj 2027 0 obj 6356 endobj 2028 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 35.56 m 566.92999 35.56 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 12 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 30.78999 Tm (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 1 0 0 1 477.67999 31.8 Tm (Page)Tj 2 Tr 1 0 0 1 508.20999 31.8 Tm (34)Tj 0 Tr 1 0 0 1 522.20001 31.8 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 31.8 Tm (44)Tj /T1_0 16 Tf 1 0 0 1 28.35001 797.57001 Tm (Requirements and recommendations from this inspection:)Tj /T1_0 12 Tf 1 0 0 1 28.35001 782.14996 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 108.12 w 32.32001 719.77997 m 564.96997 719.77997 l S 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 93.3 677.13 m 197.40001 677.13 l S 199.64998 677.13 m 289.44998 677.13 l S 291.70001 677.13 m 473.80002 677.13 l S 476.04999 677.13 m 566.10004 677.13 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.07001 689.63 m 30.07001 664.64001 l S 567.21997 689.63 m 567.21997 664.64001 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.29999 688.54999 l S 92.17 689.63 m 92.17 664.64001 l S 198.51999 689.63 m 198.51999 664.64001 l S 290.57001 689.63 m 290.57001 664.64001 l S 474.91998 689.63 m 474.91998 664.64001 l S 28.99001 776.08997 m 568.40002 776.08997 l S 28.99001 721.10004 m 568.40002 721.10004 l S 28.99001 688.54999 m 568.40002 688.54999 l S 28.99001 665.71997 m 568.29999 665.71997 l S 30.07001 777.16998 m 30.07001 687.46997 l S 92.12 722.17999 m 92.12 687.46997 l S 198.51999 722.17999 m 198.51999 687.46997 l S 290.62 722.17999 m 290.62 687.46997 l S 475.01999 722.17999 m 475.01999 687.46997 l S 567.32001 777.16998 m 567.32001 687.46997 l S 0 0 0 RG 0.5 w BT /T1_0 12 Tf 1 0 0 1 34.05 759.90002 Tm (Immediate requirements:)Tj 0 Tr 1 0 0 1 34.05 742.32001 Tm (These are immediate requirements that were set on the day we visited thi\ s care home. )Tj 1 0 0 1 34.05 727.73999 Tm (The registered person had to meet these within 48 hours.)Tj /T1_0 10 Tf 1 0 0 1 31.2 709.91998 Tm (No.)Tj 1 0 0 1 96.10001 706.91998 Tm (Standard)Tj 1 0 0 1 202.5 706.91998 Tm (Regulation)Tj 1 0 0 1 294.60001 706.91998 Tm (Requirement)Tj 1 0 0 1 479 706.91998 Tm (Timescale for )Tj 1 0 0 1 479 694.76996 Tm (action)Tj /T1_0 12 Tf 1 0 0 1 35.5 675.35999 Tm (\240)Tj 1 0 0 1 96.15001 672.35999 Tm (\240)Tj 1 0 0 1 202.5 672.35999 Tm (\240)Tj 1 0 0 1 294.54999 672.35999 Tm (\240)Tj 1 0 0 1 478.89993 672.35999 Tm (\240)Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32001 345.62 m 564.96997 345.62 l S 1 1 1 RG 289 w 31.2 382.30002 m 91.05 382.30002 l S 93.3 382.30002 m 197.40001 382.30002 l S 199.64998 382.30002 m 289.44998 382.30002 l S 291.70001 382.30002 m 473.80002 382.30002 l S 476.04999 382.30002 m 566.10004 382.30002 l S 172.64998 w 31.2 149.23 m 91.05 149.23 l S 93.3 149.23 m 197.40001 149.23 l S 199.64998 149.23 m 289.44998 149.23 l S 291.70001 149.23 m 473.80002 149.23 l S 476.04999 149.23 m 566.10004 149.23 l S 0.75294 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requirements set out what the registered person must do to meet th\ e Care )Tj 1 0 0 1 34.05 581.70001 Tm (Standards Act 2000, Care Homes)Tj 1 0 0 1 239.76999 581.70001 Tm (Regulations 2001 and the National Minimum )Tj 1 0 0 1 34.05 567.12 Tm (Standards. 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