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Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: Thu Oct 09 15:49:19 2008 % Converted from TrueType font 'ARIAL.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 2.76) readonly def /Notice (Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved) readonly def /FullName (Arial) readonly def /FamilyName (Arial) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -106 def /UnderlineThickness 73 def end readonly def /FontName /ArialMT def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {-46 -210 1000 896} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /quotedbl put dup 35 /numbersign put dup 36 /dollar put dup 37 /percent put dup 38 /ampersand put dup 39 /quotesingle put dup 40 /parenleft put dup 41 /parenright put dup 42 /asterisk put dup 43 /plus put dup 44 /comma put dup 45 /hyphen put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /at put dup 65 /A put dup 66 /B put dup 67 /C put dup 68 /D put dup 69 /E put dup 70 /F put dup 71 /G put dup 72 /H put dup 73 /I put dup 74 /J put dup 75 /K put dup 76 /L put dup 77 /M put dup 78 /N put dup 79 /O put dup 80 /P put dup 81 /Q put dup 82 /R put dup 83 /S put dup 84 /T put dup 85 /U put dup 86 /V put dup 87 /W put dup 88 /X put dup 89 /Y put dup 90 /Z put dup 91 /bracketleft put dup 92 /backslash put dup 93 /bracketright put dup 94 /asciicircum put dup 95 /underscore put dup 96 /grave put dup 97 /a put dup 98 /b put dup 99 /c put dup 100 /d put dup 101 /e put dup 102 /f put dup 103 /g put dup 104 /h put dup 105 /i put dup 106 /j put dup 107 /k put dup 108 /l put dup 109 /m put dup 110 /n put dup 111 /o put dup 112 /p put dup 113 /q put dup 114 /r put dup 115 /s put dup 116 /t put dup 117 /u put dup 118 /v put dup 119 /w put dup 120 /x put dup 121 /y put dup 122 /z put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /asciitilde put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /quotesinglbase put dup 131 /florin put dup 132 /quotedblbase put dup 133 /ellipsis put dup 134 /dagger put dup 135 /daggerdbl put dup 136 /circumflex put dup 137 /perthousand put dup 138 /Scaron put dup 139 /guilsinglleft put dup 140 /OE put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /quoteleft put dup 146 /quoteright put dup 147 /quotedblleft put dup 148 /quotedblright put dup 149 /bullet put dup 150 /endash put dup 151 /emdash put dup 152 /tilde put dup 153 /trademark put dup 154 /scaron put dup 155 /guilsinglright put dup 156 /oe put dup 157 /.notdef put dup 158 /.notdef put dup 159 /Ydieresis put dup 160 /space put dup 161 /exclamdown put dup 162 /cent put dup 163 /sterling put dup 164 /currency put dup 165 /yen put dup 166 /brokenbar put dup 167 /section put dup 168 /dieresis put dup 169 /copyright put dup 170 /ordfeminine put dup 171 /guillemotleft put dup 172 /logicalnot put dup 173 /hyphen put dup 174 /registered put dup 175 /overscore put dup 176 /degree put dup 177 /plusminus put dup 178 /twosuperior put dup 179 /threesuperior put dup 180 /acute put dup 181 /mu1 put dup 182 /paragraph put dup 183 /periodcentered put dup 184 /cedilla put dup 185 /onesuperior put dup 186 /ordmasculine put dup 187 /guillemotright put dup 188 /onequarter put dup 189 /onehalf put dup 190 /threequarters put dup 191 /questiondown put dup 192 /Agrave put dup 193 /Aacute put dup 194 /Acircumflex put dup 195 /Atilde put dup 196 /Adieresis put dup 197 /Aring put dup 198 /AE put dup 199 /Ccedilla put dup 200 /Egrave put dup 201 /Eacute put dup 202 /Ecircumflex put dup 203 /Edieresis put dup 204 /Igrave put dup 205 /Iacute put dup 206 /Icircumflex put dup 207 /Idieresis put dup 208 /Eth put dup 209 /Ntilde put dup 210 /Ograve put dup 211 /Oacute put dup 212 /Ocircumflex put dup 213 /Otilde put dup 214 /Odieresis put dup 215 /multiply put dup 216 /Oslash put dup 217 /Ugrave put dup 218 /Uacute put dup 219 /Ucircumflex put dup 220 /Udieresis put dup 221 /Yacute put dup 222 /Thorn put dup 223 /germandbls put dup 224 /agrave put dup 225 /aacute put dup 226 /acircumflex put dup 227 /atilde put dup 228 /adieresis put dup 229 /aring put dup 230 /ae put dup 231 /ccedilla put dup 232 /egrave put dup 233 /eacute put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B T13҂uGFsnA S1_ z.H@sV-umQ/ rgrVFcSctóinuk̾uA M[\b y9_ )(ib]o7PaZk=JI4wr QeR-ӐhX}Qt 1ݫja@K^ }= j"D3XU:*u?| 6&f]'(VY k?YODn7Or>TɩZfZvZ7N-N}.^1>dL,͝0n8^|0~ZPFP^̵x} Tj9th ?H2wr=\aK&cE"*X8)nXZI- Rҿ mRdokh_`V#wp; նגdRyf,jL%>lzr{,V\d6koXp a~( q;(I9zF<2(u4Z+(9%%W# )3Z+B gmMJۿ;5t2&M}wP-B*' lC7AEÐ-XaTu:RD/ ~Xmv@JO"Ⲕ!d #\8_A#~#aMzNNZ2>ieec5+#TMg]Ⴤ]p9jqe^alǣ̏:Ϯ6~O(SW™^tpTeͦVzĻ[ 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Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: Fri Oct 10 11:50:06 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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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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C <$e2"H/ 0@PpP`p0/?o /?o 7 7 **& 9999PKKTBKKSB 2+KdRBKRXYKTXYKSXY++++++++st+ststEEha#DsEEha#DsEEha#DEh#Dst++tu++++u+++++++++s+++++++++ss++sssstssssss+ss+s+u+us+u++s+++++++++++++++++++++++++++ss+s+sss++s+s++s+++++ss+++s+++s+++++ts+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ endstream endobj 100 0 obj<> endobj 101 0 obj<>/FontDescriptor 100 0 R/DW 1000>> endobj 102 0 obj<>stream /CIDInit /ProcSet findresource begin 12 dict begin begincmap /CIDSystemInfo << /Registry (Adobe) /Ordering (UCS) /Supplement 0 >> def /CMapName /Adobe-Identity-UCS def /CMapType 2 def 1 begincodespacerange <0003><005c> endcodespacerange 31 beginbfrange <0003><0003><0020> <001d><001d><003a> <0026><0026><0043> <002c><002c><0049> <002e><002e><004b> <0032><0032><004f> <0035><0035><0052> <0036><0036><0053> <0037><0037><0054> <0044><0044><0061> <0045><0045><0062> <0046><0046><0063> <0047><0047><0064> <0048><0048><0065> <0049><0049><0066> <004a><004a><0067> <004b><004b><0068> <004c><004c><0069> <004d><004d><006a> <004f><004f><006c> <0050><0050><006d> <0051><0051><006e> <0052><0052><006f> <0053><0053><0070> <0055><0055><0072> <0056><0056><0073> <0057><0057><0074> <0058><0058><0075> <005a><005a><0077> <005b><005b><0078> <005c><005c><0079> endbfrange endcmap CMapName currentdict /CMap defineresource pop end end endstream endobj 103 0 obj<>stream %!PS-AdobeFont-1.0: TimesNewRomanPSMT Typeface The Monotype Corporation plc. 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$?H}Om"s*5aks*HRUufn6i?kɝ=-0X%lϧQ4ݡ`rџ~D&#&:t]=.ok &DZђԺŠRq [j@3a*42K]sjϖjG_n 4Ϛ5. *Ly^w`ܮ64r/:!?u:};ߜ`dӤJY2R'wbTCI2CRNY2uD-.Y9y:2Cʸ`ͻq5dBpQŰ: TimM;f ]+ozY0,(Fh^ GirY E W| -R̵vVP ce޾'zH+1= PU~}fIa TY˞߹NC!RhUeySNqEobm"QQL!H0agylrҳxc: HWmֻDc,A';{ 8rnGMGduDcb ʮ_`gJuDQO>c٨~b_s/%~`/ 8Ayq. -v -%=6 ̟sjՊ6a FZ#Ԉeֆ1TRwY Կ'$s|I9ƲRM&89>N ]<3z h_/-|UN%b=̱ IuȌ>pq-t<.4Pk2\1Ko7fXH%<#+nUU[D-Jeʤvɴ;\G?W<}eH}p?_F5$wG.~< J s]tY 6Xk6UNJRg_pZ=܌JR(lh9ҥӏjwb"MF&纺ÄjhjX,Ƒwjnd-4:$fN4IyFNgXٺmS`d'G8^Ir1[cÎ$-0[d]v2O8͸\GQk_Y\2\Gp2i2^cT:ʲ 9,]YnZh?35Ƴ2Y_F]ùD"=RI:3?Gv9p= K.~hZo!Y&Bn7kECVsEvpԛt3Qk{% 񚡽ACIG#-"Uo| qB:` h͑p>gϒe$P*[!{}#1p%,H'ɷz[0 }3"" u'~Tɗϛ}:>1PQApt & / XJ4%dha ?$] |67A U)>4q Q3Kn|n  uL1tNpZB?)sWxbpi⩢խd_ŏ<\Y@D\_߰17Q"ݚ}Ž^FGW5߀klZ5srĿLZ"R"[STl(#9˳;/:7Hz4MM S^f FH|ݽ0NQy@`\|fȊP)^uĖs4$ m1*.١.fU Q>\( d{hk}%$fm aS5&i%)LdTz7&Nl$ vM?O]پ,/KTbx`~/3Ks8kÜ' CsBCY;qrRș^.[`gҪ]┛o}8H#H/g\?}7Y#*ZV PvO߃ ~bXaAI`CD ҷDO[(1YBo*uKYlLђDi6Y0@̗Ōy 0W s$}FD=-Y'r3EUð7mN/I$K̳ܨ=h!ۧ {H™Naqm*}h8だ3N++kyhB^gRţ-LjQ9h% s6?FnAnٽ6t6LMlt&n'#i^)֤0)G7a;]U@d#1Mn$]mU}iigTQ5=80"Ӯ2sl`ݗַc%7Ɉʝ;.7Rҿ¸>~ot"IģqWu)b,mXT=s5c؊m{6|HlsI%ر95Oq2&宠9hbLTu˷| iHKC6 Dί!isaX4r]Clq )_Ħr98y&XZ%.ЏB'$9.Htxl8s~*lq}rM⹟8_j_V~%)_EW_K/3ND^3BpGݩ|G9jS6@`'XȽ$` Y&ypCeֳHΪFzjt) 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ډ`0%ü[Ptt%14i1h}l_\]g!XO*9鼯q&RM[-RHGZN;P\37яmB.eʳd7Q5łs9 E Tli/wy/lʀ5|Wq `tN%7Lyv7@9,BPcmq@U8'<[A;bƮd~6p!Nd^%? 7G&ݜϖdScw;Y_L#vicAղ@cϘr\ u|tاYy&Jp43/u `a)>(j=cңOKjYR*eɔx"[惷܍D S;Օnx` +umꠉ.հE%%H~DWD]8e1ј:3>ot_|:gY{=HXP:=\:|[܂U>#GFT~p(|N8fv^ITwy+ ѯo' wRRv/FѢ+70wm`[$9@m]woa~`m%v š7Gbޮ2dhj%KZ 'pa[Cր!L:WtC:ԇHA156;KQi2B\$IeR_6BUoRE\_S艖{DIg.̀l7 ާzG}|9AU,yAt3eNc}^;R- jVfOQZ #/Wzxo`t^,`!d&ϧ PZ$b˹HUX 5H[ƐE}B?yMwWwkR0 $)ZEjtQEnje;US\XJqKH3['%^UF_6O)זH`T hVȀ{ -Q*~P\Iҵ%C.hl{*P*0Kt^JΎ%;QܞXՠ4^B nձrSӈnȺa7<`!;Ȗ[<4'W1 tT,9j`1GS,>Z N%LxȿWܩuD$@.}^d@/{46\U^bۙ qjm]ub1TCD,WG=`Hh#à3/ELĢ͂^t 777G4yеRF Ҏ/s.dC](b'`%WTԷMŃcQ}JY^xC9溠іfnĠZr=nVx&>|tFCr䊧+$wy@ t+ˍa:ˋ.e.Qq6]Y7aGbS!]~ u:?!W]Fn85x:TV兑 ?洢E}@<sϋmTFk_2Sq F96 CvkPiyn.[s[v4)vp7+oC(gu$ft.ΝwU*pjG(g;{ |3PʺyEڞ_g&-髁Onht4ET-`42_S#:o|z6H擲Yg@Vsua;^xwLn@z v63K|$I-dp7(|D^h3# r C~ ȱـxk>E"B >' a< o묿amqZSM-{/W29("< [_͇HKp\.ĭxJ@q=Tؚ%ILcLg=5w'Y@xkQnpF|X2'Q*y,Bd뙪^g h)+'0LqbV0Op{ 4e)pN:~R R2ހTxn#0]7-YB3,JtZ̆ `s3H~Cw/Ni'(h#4redD>dCM]zُmmX?=?Ufqv:ɱ公%ICg~M) i{NDG1g'خ(DЋuޝrȁ& W=W 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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 128.64 w 28.35001 223.5 m 224.04999 223.5 l S 1 1 1 RG 226.3 223.5 m 567 223.5 l S 0.95294 0.95294 0.95294 RG 38.16 w 28.35001 137.84999 m 224.04999 137.84999 l S 1 1 1 RG 226.3 137.84999 m 567 137.84999 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 26.14 158.05 m 569.20001 158.05 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 26.14 158.05 m 569.20001 158.05 l S 26.14 117.64 m 569.20001 117.64 l S 27.22 381.34 m 27.22 116.57001 l S 225.17 381.34 m 225.17 116.57001 l S 568.12 381.34 m 568.12 116.57001 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 (\251 Care Quality Commission 2010)Tj 1 0 0 1 229.14998 255.17998 Tm (This publication may be reproduced in whole or in part )Tj 1 0 0 1 229.14998 240.60001 Tm (in any format or medium for non-commercial purposes, )Tj 1 0 0 1 229.14998 226.01999 Tm (provided that it is reproduced accurately and not used )Tj 1 0 0 1 229.14998 211.44 Tm (in a derogatory manner or in a misleading context. The )Tj 1 0 0 1 229.14998 196.86 Tm (source should be acknowledged, by showing the )Tj 1 0 0 1 229.14998 182.28 Tm (publication title and \251 Care Quality Commission 2010.)Tj 1 0 0 1 31.2 141.87 Tm (Internet address)Tj 1 0 0 rg 1 0 0 1 229.14998 141.87 Tm (www.cqc.org.uk)Tj ET endstream endobj 557 0 obj 8972 endobj 558 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 (36)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 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316.98999 m 567.79999 316.98999 l S 28.99001 279.57999 m 567.79999 279.57999 l S 28.99001 256.75 m 568.10004 256.75 l S 28.99001 233.92 m 568.10004 233.92 l S 28.99001 167.34999 m 568.10004 167.34999 l S 30.07001 340.88998 m 30.07001 166.26999 l S 298.41998 340.88998 m 298.41998 278.5 l S 432.56998 340.88998 m 432.56998 278.5 l S 566.71997 340.88998 m 566.71997 166.26999 l S BT /T1_0 12 Tf 1 0 0 1 34.05 323.63 Tm (dementia)Tj 1 0 0 1 302.39999 323.63 Tm (49)Tj 1 0 0 1 436.54999 323.63 Tm (0)Tj 1 0 0 1 34.05 300.80002 Tm (mental disorder, excluding learning )Tj 1 0 0 1 34.05 286.22 Tm (disability or dementia)Tj 1 0 0 1 302.39999 300.80002 Tm (49)Tj 1 0 0 1 436.54999 300.80002 Tm (0)Tj 1 0 0 1 34.05 263.38998 Tm (Additional conditions: )Tj 1 0 0 1 34.05 240.56 Tm (The maximum number of service users who can be accommodated is: 49)Tj 1 0 0 1 34.05 217.73 Tm (The registered person may provide the following category of service only\ : Care Home )Tj 1 0 0 1 34.05 203.14998 Tm (with Nursing \(Code N\); To service users of the following gender: Eithe\ r; Whose primary )Tj 1 0 0 1 34.05 188.56999 Tm (care needs on admission to the home are within the following categories:\ Dementia )Tj 1 0 0 1 34.05 173.98999 Tm (\(DE\) 49, Mental disorder, excluding learning disability or dementia \(\ MD\) 49)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 152.56 m 315.25 152.56 l S 1 1 1 RG 317.5 152.56 m 346.54999 152.56 l S 348.80002 152.56 m 377.89999 152.56 l S 380.14999 152.56 m 409.20001 152.56 l S 411.44998 152.56 m 440.54999 152.56 l S 442.80002 152.56 m 471.89993 152.56 l S 474.14993 152.56 m 503.20001 152.56 l S 505.44998 152.56 m 534.54999 152.56 l S 536.79999 152.56 m 565.90002 152.56 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 163.97 m 568.10004 163.97 l S 28.99001 141.14 m 568.10004 141.14 l S 30.07001 165.05 m 30.07001 140.06999 l S 316.37 165.05 m 316.37 140.06999 l S 347.66998 165.05 m 347.66998 140.06999 l S 379.01999 165.05 m 379.01999 140.06999 l S 410.31998 165.05 m 410.31998 140.06999 l S 441.66998 165.05 m 441.66998 140.06999 l S 473.01999 165.05 m 473.01999 140.06999 l S 504.31998 165.05 m 504.31998 140.06999 l S 535.66998 165.05 m 535.66998 140.06999 l S 567.01996 165.05 m 567.01996 140.06999 l S BT /T1_0 12 Tf 1 0 0 1 34.05 147.78999 Tm (Date of last inspection)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 129.27 m 565.90002 129.27 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 119.64 m 568.10004 119.64 l S 30.07001 120.72 m 30.07001 39.14999 l S 567.01996 120.72 m 567.01996 39.14999 l S 28.99001 138.89 m 568.10004 138.89 l S 28.99001 119.64 m 568.10004 119.64 l S 28.99001 40.22 m 568.10004 40.22 l S 30.07001 139.97 m 30.07001 118.57001 l S 567.01996 139.97 m 567.01996 118.57001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 125.71001 Tm (Brief description of the )Tj 1 0 0 1 177.31 125.71001 Tm (care home)Tj 1 0 0 1 35.5 106.46001 Tm (Holmer Care Centre is on the outskirts of the city of Hereford. It is ow\ ned and )Tj 1 0 0 1 35.5 89.46001 Tm (managed by The Holmer Partnership, Blanchworth Care. The Home was first \ opened in )Tj 1 0 0 1 35.5 72.46001 Tm (December 1991. It is a Victorian property that has been extended to prov\ ide a Care )Tj 1 0 0 1 35.5 55.46001 Tm (Home with nursing for a maximum of 49 older persons over the age of 65 y\ ears, of )Tj ET endstream endobj 559 0 obj 2157 endobj 560 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 (36)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 638.07996 l S 567.01996 795.47998 m 567.01996 638.07996 l S 28.99001 813.64996 m 568.10004 813.64996 l S 28.99001 794.40002 m 568.10004 794.40002 l S 28.99001 639.14996 m 568.10004 639.14996 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 (both sexes, who have dementia or a mental disorder. Twenty nine bedrooms\ are single )Tj 1 0 0 1 33.25 766.46997 Tm (occupancy, eighteen have en-suite facilities. The Home has a passenger l\ ift. The Home )Tj 1 0 0 1 33.25 749.46997 Tm (operates a 'locked door' policy, as indicated in the Home's Statement of\ Purpose and )Tj 1 0 0 1 33.25 732.46997 Tm (Service User guide. \240 There is information literature describing the \ service displayed at )Tj 1 0 0 1 33.25 715.46997 Tm (the home and copies are available on the Provider's website address. New\ residents )Tj 1 0 0 1 33.25 698.46997 Tm (receive a copy of this information and it also forms part of staff induc\ tion )Tj 1 0 0 1 33.25 681.46997 Tm (packs.)Tj 1 0 0 1 71.91 681.46997 Tm ( \240 )Tj 1 0 0 1 84.58 681.46997 Tm (Details)Tj 1 0 0 1 125.75 681.46997 Tm ( of fees and additional charges are available from the Provider's websit\ e )Tj 1 0 0 1 33.25 664.46997 Tm (address. A copy of this report can be viewed at the )Tj 1 0 0 1 346.70001 664.46997 Tm (home.)Tj 1 0 0 1 384.76999 664.46997 Tm ( \240)Tj 1 0 0 1 33.25 647.46997 Tm (\240)Tj ET endstream endobj 561 0 obj 3510 endobj 562 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 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 (36)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 /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 (We stopped awarding quality \('star'\) ratings under the Care Standards \ Act 2000 on 30 )Tj 1 0 0 1 35.17 240.90001 Tm (June 2010. No new ratings have been awarded since that date. For this re\ ason, the )Tj 1 0 0 1 35.17 226.31998 Tm (report should be read in full so that an accurate view of the quality of\ the service can )Tj 1 0 0 1 35.17 211.73999 Tm (be obtained.)Tj 1 0 0 1 35.17 197.14998 Tm (\240)Tj 1 0 0 1 35.17 182.56999 Tm (This was an unannounced inspection. Two inspectors, and a pharmacist ins\ pector, )Tj 1 0 0 1 35.17 167.98999 Tm (spent a full day at the home, talking to the people who use the service \ and the staff, )Tj 1 0 0 1 35.17 153.41 Tm (observing daily life in the home, and looking at the records, which must\ be kept by the )Tj 1 0 0 1 35.17 138.84 Tm (home to show that it is being run properly. These include records relati\ ng to the care of )Tj 1 0 0 1 35.17 124.25 Tm (people who use the service. We looked in detail at the records for four \ people living at )Tj 1 0 0 1 35.17 109.68001 Tm (the home.)Tj 1 0 0 1 35.17 95.10001 Tm (\240)Tj 1 0 0 1 35.17 80.50999 Tm (The service had previously completed an Annual Quality Assurance Assessm\ ent )Tj 1 0 0 1 35.17 65.93001 Tm (\(AQAA\). The AQAA is a self-assessment that focuses on how well outcome\ s are being )Tj ET endstream endobj 563 0 obj 956 endobj 564 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 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 (36)Tj ET 1 1 1 RG 46.74001 w 32.32001 789.15997 m 566.71997 789.15997 l S 0.75294 0.75294 0.75294 RG 2.25 w 30.12 813.64996 m 568.91998 813.64996 l S 30.12 764.65997 m 568.91998 764.65997 l S 31.2 814.72998 m 31.2 763.58997 l S 567.84998 814.72998 m 567.84998 763.58997 l S BT /T1_0 12 Tf 0 Tr 1 0 0 1 32.92 802.71997 Tm (met for people using the service. It also gives us some numerical inform\ ation about the )Tj 1 0 0 1 32.92 788.13995 Tm (service. Some of the manager's comments have been included within this i\ nspection )Tj 1 0 0 1 32.92 773.56 Tm (report.)Tj ET endstream endobj 565 0 obj 5783 endobj 566 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 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 (36)Tj ET 1 1 1 RG 20.58 w 31.2 786.35999 m 567.84998 786.35999 l S 78.90001 w 32.32001 734.37 m 566.71997 734.37 l S 20.58 w 32.7 682.38 m 569.34998 682.38 l S 93.48 w 33.82001 623.10004 m 568.21997 623.10004 l S 20.58 w 33.45 563.82001 m 570.10004 563.82001 l S 326.75998 w 34.57001 387.89999 m 568.96997 387.89999 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 30.12 693.79999 m 568.91998 693.79999 l S 31.2 776.02997 m 31.2 692.71997 l S 31.2 693.79999 m 569.34998 693.79999 l S 32.7 670.96997 m 569.34998 670.96997 l S 31.62 670.96997 m 570.41998 670.96997 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 32.37 223.40001 m 571.16998 223.40001 l S 32.7 672.04999 m 32.7 574.15997 l S 33.45 553.48999 m 33.45 222.31998 l S 567.84998 776.02997 m 567.84998 692.71997 l S 569.34998 672.04999 m 569.34998 574.15997 l S 570.10004 553.48999 m 570.10004 222.31998 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 home provides a range of information to help people decide if they w\ ish to move )Tj 1 0 0 1 35.17 744.17999 Tm (into the home. The home makes sure that people's needs are assessed befo\ re they )Tj 1 0 0 1 35.17 729.60004 Tm (move in, so that staff know the support that needs to be provided.)Tj 1 0 0 1 35.17 715.01996 Tm (\240)Tj 1 0 0 1 35.17 700.44 Tm (The home encourages relatives and friends to visit, and makes them welco\ me.)Tj /T1_0 10 Tf 1 0 0 1 568.96997 732.82001 Tm (\240)Tj 1 0 0 1 31.2 680.26996 Tm (\240)Tj /T1_0 12 Tf 2 Tr 1 0 0 1 32.7 677.60999 Tm (What has improved since the last inspection?)Tj /T1_0 10 Tf 0 Tr 1 0 0 1 569.34998 680.82996 Tm (\240)Tj 1 0 0 1 31.2 621.54999 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 36.67 654.77997 Tm (The home has reviewed some risk assessments, specifically in relation to\ the risk of )Tj 1 0 0 1 36.67 640.20001 Tm (falls.)Tj 1 0 0 1 36.67 625.62 Tm (\240)Tj 1 0 0 1 36.67 611.03998 Tm (The home has reviewed care plans about managing people's behaviour, and \ these give )Tj 1 0 0 1 36.67 596.45996 Tm (staff clear instructions about how to support people whose behaviour cou\ ld pose a risk )Tj 1 0 0 1 36.67 581.88 Tm (to themselves or others.)Tj /T1_0 10 Tf 1 0 0 1 570.46997 621.54999 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 31.2 386.35001 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 37.42 536.21997 Tm (People cannot be confident that their physical and mental health care ne\ eds will be )Tj 1 0 0 1 37.42 521.64001 Tm (identified and met. Medication is not managed safely. There is a lack of\ basic )Tj 1 0 0 1 37.42 507.06 Tm (understanding about how to promote and protect people's privacy and dign\ ity.)Tj 1 0 0 1 37.42 492.47998 Tm (\240)Tj 1 0 0 1 37.42 477.89993 Tm (People cannot be fully confident that concerns will be listened to and r\ esolved. Staff )Tj 1 0 0 1 37.42 463.31998 Tm (know who to contact if people are abused, but evidence elsewhere in the \ report shows )Tj 1 0 0 1 37.42 448.73999 Tm (that people are at risk of neglect.)Tj 1 0 0 1 37.42 434.16 Tm (\240)Tj 1 0 0 1 37.42 419.57999 Tm (Holmer Care Centre does not provide a safe or homely environment for peo\ ple, and the )Tj 1 0 0 1 37.42 405 Tm (home is not kept clean and hygienic.)Tj 1 0 0 1 37.42 390.41998 Tm (\240)Tj 1 0 0 1 37.42 375.84 Tm (Staff do not always receive the training they need to provide support fo\ r people living )Tj 1 0 0 1 37.42 361.25998 Tm (at the home. There are not enough staff on duty to meet people's needs.)Tj 1 0 0 1 37.42 346.67999 Tm (\240)Tj 1 0 0 1 37.42 332.10001 Tm (The home lacks direction and leadership, and this has had a negative imp\ act on people )Tj 1 0 0 1 37.42 317.51999 Tm (living at the home. Some aspects of health and safety are not adequately\ managed.)Tj 1 0 0 1 37.42 302.94 Tm (\240)Tj 1 0 0 1 37.42 288.35999 Tm (Some requirements from previous inspections, relating to health and pers\ onal care, )Tj 1 0 0 1 37.42 273.78 Tm (infection control, and medication, have not been met, so we are serving \ Statutory )Tj 1 0 0 1 37.42 259.20001 Tm (Requirement Notices. The unmet requirements from previous inspections ar\ e now )Tj 1 0 0 1 37.42 244.62 Tm (covered in the Statutory Requirement Notices, which can be seen at the e\ nd of the )Tj 1 0 0 1 37.42 230.03998 Tm (report.)Tj 1 0 0 1 28.35001 207.70999 Tm (\240)Tj 1 0 0 1 28.35001 187.72 Tm (If you want to know what action the person responsible for this )Tj 1 0 0 1 416.37 187.72 Tm (care home)Tj 1 0 0 1 480.03998 187.72 Tm ( is taking )Tj 1 0 0 1 28.35001 170.22 Tm (following this report, you can contact them using the details on page 4.\ )Tj 1 0 0 1 28.35001 150.23 Tm (\240)Tj 1 0 0 1 28.35001 130.23 Tm (The report of this inspection is available from our website )Tj 1 0 0 1 380.85001 130.23 Tm (www.cqc.org.uk.)Tj 1 0 0 1 28.35001 110.23 Tm (You can get printed copies from )Tj 1 0 0 1 225.22 110.23 Tm (enquiries@cqc.org.uk or by telephoning our)Tj 1 0 0 1 28.35001 90.24001 Tm (order line 0870 240 7535.)Tj ET endstream endobj 567 0 obj 1803 endobj 568 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 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 (36)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 569 0 obj 5932 endobj 570 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (10)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (36)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 124.35001 w 34.60001 378 m 562.53998 378 l S 1 1 1 RG 22.5 w 32.35001 431.16998 m 564.78998 431.16998 l S 101.85001 w 33.47 366.75 m 563.65997 366.75 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 313.62 l S 564.78998 419.88 m 564.78998 313.62 l S 32.35001 418.80002 m 564.78998 418.80002 l S 31.27 314.70001 m 565.87 314.70001 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 (good)Tj 0 Tr 1 0 0 1 292.91998 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 (People have access to written information to help them decide if they wi\ sh to move )Tj 1 0 0 1 36.62 341.25 Tm (into Holmer Care Centre. The home makes sure that people's needs are ass\ essed )Tj 1 0 0 1 36.62 323.75998 Tm (before they move in, so that staff know the support that needs to be pro\ vided.)Tj 1 0 0 1 28.35001 299.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 206.8 w 34.60001 185.42999 m 562.53998 185.42999 l S 1 1 1 RG 22.5 w 32.35001 279.82999 m 564.78998 279.82999 l S 185.42999 w 33.47 173.62 m 563.65997 173.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 267.44998 m 565.87 267.44998 l S 32.35001 268.53 m 32.35001 78.70001 l S 564.78998 268.53 m 564.78998 78.70001 l S 32.35001 267.44998 m 564.78998 267.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 276.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 251.76999 Tm (The home provides a range of written information which is given to peopl\ e before they )Tj 1 0 0 1 36.57001 234.26999 Tm (move in. There is also a website with useful information about the home.\ We saw that )Tj 1 0 0 1 36.57001 216.78 Tm (the Service User Guide had been updated recently to include information \ about the )Tj 1 0 0 1 36.57001 199.28 Tm (changes to the management of the home. The information available would h\ elp people )Tj 1 0 0 1 36.57001 181.78998 Tm (to make an informed choice about whether Holmer Care Centre was the righ\ t place for )Tj 1 0 0 1 36.57001 164.28999 Tm (them. In the AQAA, the home states "Any prospective resident is offered \ a trial period )Tj 1 0 0 1 36.57001 146.78999 Tm (stay to ensure that they feel comfortable within the home and the home m\ anages )Tj 1 0 0 1 36.57001 129.3 Tm (their care well.")Tj 1 0 0 1 36.57001 111.8 Tm (\240)Tj 1 0 0 1 36.57001 94.31 Tm (We spoke to a relative of someone who lives at the home. They told us th\ at they had )Tj ET endstream endobj 571 0 obj 1917 endobj 572 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (11)Tj 0 Tr 1 0 0 1 522.20001 53.03999 Tm ( of )Tj 2 Tr 1 0 0 1 540.48999 53.03999 Tm (36)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 178.84 w 34.60001 721.98999 m 562.53998 721.98999 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 157.45999 w 33.47 710.17999 m 563.65997 710.17999 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 629.23999 l S 564.78998 791.10999 m 564.78998 629.23999 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 630.32001 m 565.87 630.32001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (been able to visit the home before the person moved in.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (We looked at the care records for two people to see if their needs had b\ een assessed )Tj 1 0 0 1 34.32001 726.60999 Tm (before they moved into the home. The records showed that a senior member\ of staff )Tj 1 0 0 1 34.32001 709.10999 Tm (from the home had carried out an assessment so that the home could be su\ re that it )Tj 1 0 0 1 34.32001 691.62 Tm (could meet each person's individual needs, and so that staff would know \ the care that )Tj 1 0 0 1 34.32001 674.12 Tm (needed to be provided. These assessments were brief but there was eviden\ ce that a )Tj 1 0 0 1 34.32001 656.63 Tm (fuller picture of the person's needs and preferences had been built up o\ ver the first )Tj 1 0 0 1 34.32001 639.13 Tm (few weeks at the home.)Tj ET endstream endobj 573 0 obj 5853 endobj 574 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (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 (36)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 124.35001 w 34.60001 412 m 562.53998 412 l S 1 1 1 RG 22.5 w 32.35001 465.16998 m 564.78998 465.16998 l S 101.85001 w 33.47 400.75 m 563.65997 400.75 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 347.62 l S 564.78998 453.88 m 564.78998 347.62 l S 32.35001 452.80002 m 564.78998 452.80002 l S 31.27 348.70001 m 565.87 348.70001 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 cannot be confident that their physical and mental health care ne\ eds will be )Tj 1 0 0 1 36.62 375.25 Tm (identified and met. Medication is not managed safely. There is a lack of\ basic )Tj 1 0 0 1 36.62 357.75998 Tm (understanding about how to promote and protect people's privacy and dign\ ity.)Tj 1 0 0 1 28.35001 333.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 240.8 w 34.60001 202.42998 m 562.53998 202.42998 l S 1 1 1 RG 22.5 w 32.35001 313.82999 m 564.78998 313.82999 l S 219.42998 w 33.47 190.62 m 563.65997 190.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 301.44998 m 565.87 301.44998 l S 32.35001 302.53 m 32.35001 78.70001 l S 564.78998 302.53 m 564.78998 78.70001 l S 32.35001 301.44998 m 564.78998 301.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 310.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 285.76999 Tm (We looked at the care records for four people who live at the home. We a\ lso talked )Tj 1 0 0 1 36.57001 268.26999 Tm (with staff who provide their care and observed how staff support them.)Tj 1 0 0 1 36.57001 250.78 Tm (\240)Tj 1 0 0 1 36.57001 233.28 Tm (We saw that most care plans had been reviewed and updated when people's \ needs )Tj 1 0 0 1 36.57001 215.78998 Tm (change, but that some were out of date or incomplete, and did not give s\ taff the )Tj 1 0 0 1 36.57001 198.28998 Tm (information they need to meet people's care needs.)Tj 1 0 0 1 36.57001 180.78998 Tm (\240)Tj 1 0 0 1 36.57001 163.3 Tm (The care records for one person included a care plan for eating and drin\ king. The care )Tj 1 0 0 1 36.57001 145.8 Tm (plan stated "encourage plenty of fluids". We saw that staff were keeping\ a record of )Tj 1 0 0 1 36.57001 128.31 Tm (the amount that the person was drinking each day. We checked the records\ , and saw )Tj 1 0 0 1 36.57001 110.81 Tm (that the amount recorded over one period of twenty-four hours was 600 mi\ llilitres. )Tj 1 0 0 1 36.57001 93.31 Tm (The Food Standards Agency recommends that adults should drink 1.2 litres\ per day in )Tj ET endstream endobj 575 0 obj 5336 endobj 576 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (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 (36)Tj /T1_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 (order to prevent dehydration. We asked the Director of Nursing about the\ home's )Tj 1 0 0 1 34.32001 761.60004 Tm (procedures for recording people's fluid intake. She stated that the day'\ s total should )Tj 1 0 0 1 34.32001 744.10999 Tm (be recorded and if this showed that an inadequate amount of fluids had b\ een taken, )Tj 1 0 0 1 34.32001 726.60999 Tm (then staff should record this in the care plan. We saw that there was no\ record in the )Tj 1 0 0 1 34.32001 709.10999 Tm (care plan of the person's fluid intake. The person was not able to get d\ rinks )Tj 1 0 0 1 34.32001 691.62 Tm (independently, and needed to rely on staff to provide them. It is theref\ ore extremely )Tj 1 0 0 1 34.32001 674.12 Tm (important that records are accurate and that prompt action is taken to e\ nsure that )Tj 1 0 0 1 34.32001 656.63 Tm (people are not at risk of dehydration.)Tj 1 0 0 1 34.32001 639.13 Tm (\240)Tj 1 0 0 1 34.32001 621.63 Tm (We found that the home has an inconsistent approach to managing wound ca\ re. )Tj 1 0 0 1 34.32001 604.14001 Tm (Records for one person included clear instructions for staff about care \ of a leg wound, )Tj 1 0 0 1 34.32001 586.64001 Tm (and there was evidence that staff had closely monitored the wound and th\ at it had )Tj 1 0 0 1 34.32001 569.14996 Tm (subsequently healed. However, when we looked at records for another pers\ on with a )Tj 1 0 0 1 34.32001 551.64996 Tm (pressure sore, we found that the records were not clear and did not show\ accurate )Tj 1 0 0 1 34.32001 534.14996 Tm (and effective monitoring of the sore. We spoke to a care worker about th\ is person's )Tj 1 0 0 1 34.32001 516.65997 Tm (pressure sore, and we were told that the person should have a dressing o\ n the sore at )Tj 1 0 0 1 34.32001 499.16 Tm (all times. The care worker told us that the dressing had been removed at\ 08:00 )Tj 1 0 0 1 34.32001 481.66998 Tm (because it was soiled. She said that she had asked a nurse to replace th\ e dressing but )Tj 1 0 0 1 34.32001 464.16998 Tm (that this had not been done. The nurse confirmed that the dressing had s\ till not been )Tj 1 0 0 1 34.32001 446.66998 Tm (replaced more than five hours later. When the nurse eventually replaced \ the dressing, )Tj 1 0 0 1 34.32001 429.17999 Tm (we found that the wrong dressing had been used. The management of pressu\ re sores )Tj 1 0 0 1 34.32001 411.67999 Tm (requires specialist knowledge, but there was no evidence that the home h\ ad requested )Tj 1 0 0 1 34.32001 394.19 Tm (support for this person from the local Tissue Viability Nurse.)Tj 1 0 0 1 34.32001 376.69 Tm (\240)Tj 1 0 0 1 34.32001 359.19 Tm (Although care plans include clear instructions for staff about how to su\ pport people )Tj 1 0 0 1 34.32001 341.70001 Tm (who need help with their mobility, we found that staff were using unsafe\ techniques )Tj 1 0 0 1 34.32001 324.20001 Tm (when assisting people. At our previous inspection, we had seen staff usi\ ng an unsafe )Tj 1 0 0 1 34.32001 306.70999 Tm (technique, and we were disappointed to find that staff were still not al\ ways supporting )Tj 1 0 0 1 34.32001 289.20999 Tm (people in a safe manner. We saw staff beginning to use an underarm drag \ when )Tj 1 0 0 1 34.32001 271.70999 Tm (assisting someone to use a stand aid hoist. An underarm drag places the \ person at )Tj 1 0 0 1 34.32001 254.22 Tm (risk of injury to the shoulders and upper arm. The Director of Nursing i\ mmediately )Tj 1 0 0 1 34.32001 236.72 Tm (stopped staff from using this technique. It concerns us that staff are s\ till carrying out )Tj 1 0 0 1 34.32001 219.23 Tm (moving and handling in an unsafe manner, especially as we were shown evi\ dence that )Tj 1 0 0 1 34.32001 201.73 Tm (staff have recently received training in this area.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (At our last inspection, we had been concerned that some people living at\ the home )Tj 1 0 0 1 34.32001 149.23999 Tm (were left in the lounges for long periods of time with no staff. This in\ cluded people )Tj 1 0 0 1 34.32001 131.75 Tm (whose behaviour could present a risk to themselves or to others. We made\ a )Tj 1 0 0 1 34.32001 114.25 Tm (requirement that the home must provide adequate staffing resources to en\ sure )Tj 1 0 0 1 34.32001 96.75 Tm (people's safety.)Tj ET endstream endobj 577 0 obj 4814 endobj 578 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (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 (36)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 728.25 w 34.60001 447.28 m 562.53998 447.28 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 706.88 w 33.47 435.47 m 563.65997 435.47 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 79.82001 l S 564.78998 791.10999 m 564.78998 79.82001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 80.90001 m 565.87 80.90001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (\240)Tj 1 0 0 1 34.32001 761.60004 Tm (When we arrived at the home, the Director of Nursing told us that the la\ rge lounge on )Tj 1 0 0 1 34.32001 744.10999 Tm (the ground floor was staffed at all times from breakfast time onwards. W\ e found that )Tj 1 0 0 1 34.32001 726.60999 Tm (there were no staff in the large lounge on the ground floor when we went\ in there at )Tj 1 0 0 1 34.32001 709.10999 Tm (10:25. There were nine people who live at the home sitting in the lounge\ . We saw that )Tj 1 0 0 1 34.32001 691.62 Tm (five of the men in the lounge appeared unkempt and unshaven. We stayed i\ n the )Tj 1 0 0 1 34.32001 674.12 Tm (lounge until 10:40, and during that time there was no member of staff st\ ationed in the )Tj 1 0 0 1 34.32001 656.63 Tm (lounge.)Tj 1 0 0 1 34.32001 639.13 Tm (\240)Tj 1 0 0 1 34.32001 621.63 Tm (In the evening we saw two women who live at the home walking up and down\ a )Tj 1 0 0 1 34.32001 604.14001 Tm (corridor. One of the women had bare feet. The women appeared to be searc\ hing for )Tj 1 0 0 1 34.32001 586.64001 Tm (something or someone, but were not able to articulate their needs to us.\ There were )Tj 1 0 0 1 34.32001 569.14996 Tm (three other people who live at the home seated in armchairs. One man got\ up and )Tj 1 0 0 1 34.32001 551.64996 Tm (started undressing himself.)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj 1 0 0 1 34.32001 516.65997 Tm (We were concerned so we went into the large lounge to try to find a memb\ er of staff. )Tj 1 0 0 1 34.32001 499.16 Tm (There were no staff in the lounge. Two people in the lounge were visibly\ distressed. )Tj 1 0 0 1 34.32001 481.66998 Tm (We saw that one person had a substantial amount of a yellow substance on\ their chin )Tj 1 0 0 1 34.32001 464.16998 Tm (and clothing. The substance was seen to be congealed liquid, and had the\ same )Tj 1 0 0 1 34.32001 446.66998 Tm (appearance as the soup served at supper. Supper had been served more tha\ n three )Tj 1 0 0 1 34.32001 429.17999 Tm (hours earlier.)Tj 1 0 0 1 34.32001 411.67999 Tm (\240)Tj 1 0 0 1 34.32001 394.19 Tm (Another person sitting in the lounge at the time called out several time\ s that they )Tj 1 0 0 1 34.32001 376.69 Tm (wanted help to get to bed. The person was becoming distressed. We reassu\ red the )Tj 1 0 0 1 34.32001 359.19 Tm (person and went to find a member of staff.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (Our observations during the day, in the communal areas of the home and i\ n people's )Tj 1 0 0 1 34.32001 306.70999 Tm (bedrooms, show that people's needs in respect of their mental health are\ not being )Tj 1 0 0 1 34.32001 289.20999 Tm (met at the home. There were long periods of time when people were sittin\ g with )Tj 1 0 0 1 34.32001 271.70999 Tm (nothing to do. Research quoted by the Alzheimer's Society states that "i\ nactivity and )Tj 1 0 0 1 34.32001 254.22 Tm (low levels of engagement contribute to loss of physical function, social\ isolation, )Tj 1 0 0 1 34.32001 236.72 Tm (behavioural symptoms and poor quality of life". We say more about this i\ n the section )Tj 1 0 0 1 34.32001 219.23 Tm (on Daily Life and Social Activities.)Tj 1 0 0 1 34.32001 201.73 Tm (\240)Tj 1 0 0 1 34.32001 184.23 Tm (At the previous random inspections that took place in July 2010, seven r\ equirements )Tj 1 0 0 1 34.32001 166.73999 Tm (were made with respect to how the home was managing the medicines of the\ people )Tj 1 0 0 1 34.32001 149.23999 Tm (who used the service. We found at this inspection that the home had met \ two of these )Tj 1 0 0 1 34.32001 131.75 Tm (requirements but still needed to improve in some areas in order to compl\ y with the )Tj 1 0 0 1 34.32001 114.25 Tm (other four requirements.)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 579 0 obj 5153 endobj 580 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 11 Tf 1 0 0 1 477.67999 53.03999 Tm (Page )Tj 2 Tr 1 0 0 1 508.20999 53.03999 Tm (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 (36)Tj /T1_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 found that the security of medicines had improved because the nursing\ staff were )Tj 1 0 0 1 34.32001 761.60004 Tm (now keeping the keys to the trolleys and medication storage cupboards on\ their )Tj 1 0 0 1 34.32001 744.10999 Tm (person.)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We found that they had put in place process to ensure that the nursing s\ taff were not )Tj 1 0 0 1 34.32001 691.62 Tm (disrupted during the medication rounds, and therefore this meant that th\ e rounds )Tj 1 0 0 1 34.32001 674.12 Tm (were being completed more efficiently, and people using the service were\ receiving )Tj 1 0 0 1 34.32001 656.63 Tm (their medicines much closer to the times specified on the administration\ records.)Tj 1 0 0 1 34.32001 639.13 Tm (\240)Tj 1 0 0 1 34.32001 621.63 Tm (We also found that the nursing staff had attended training on the safe h\ andling of )Tj 1 0 0 1 34.32001 604.14001 Tm (medicines. We also found that the home had introduced and carried out as\ sessments )Tj 1 0 0 1 34.32001 586.64001 Tm (on the majority of the nursing staff to establish their competency to ha\ ndle and )Tj 1 0 0 1 34.32001 569.14996 Tm (administer medicines safely. The home had found that the nursing staff t\ hat had been )Tj 1 0 0 1 34.32001 551.64996 Tm (assessed were competent to handle and administer medicines safely, howev\ er in light )Tj 1 0 0 1 34.32001 534.14996 Tm (of what was found below the home need to take further action on this.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We found that the home had introduced a medication handover sheet which \ was used )Tj 1 0 0 1 34.32001 481.66998 Tm (to communicate issues around medication to the new shift members. We fou\ nd that )Tj 1 0 0 1 34.32001 464.16998 Tm (this process had contributed to the home ensuring that medicines were av\ ailable in )Tj 1 0 0 1 34.32001 446.66998 Tm (the home to be administered.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (In order to assess whether medicines were being administered as prescrib\ ed an audit )Tj 1 0 0 1 34.32001 394.19 Tm (of the medication records was carried out on a number of people living i\ n the home.)Tj 1 0 0 1 34.32001 376.69 Tm (\240)Tj 1 0 0 1 34.32001 359.19 Tm (With the first person we examined we found a capsule of a medicine used \ to treat )Tj 1 0 0 1 34.32001 341.70001 Tm (Parkinson's disease was missing from the monitored dosage system, and we\ could find )Tj 1 0 0 1 34.32001 324.20001 Tm (no explanation for this. We also found with a medicine that was used to \ treat )Tj 1 0 0 1 34.32001 306.70999 Tm (conditions related to excess stomach acid that 28 capsules had been rece\ ived by the )Tj 1 0 0 1 34.32001 289.20999 Tm (home and the records showed that 17 of these capsules had been administe\ red. We )Tj 1 0 0 1 34.32001 271.70999 Tm (therefore expected to find 11 capsules remaining instead we found 12 cap\ sules. We )Tj 1 0 0 1 34.32001 254.22 Tm (found with some analgesic tablets which had been prescribed with a varia\ ble dose that )Tj 1 0 0 1 34.32001 236.72 Tm (the home had not fully recorded the amount that was administered. This m\ eant that )Tj 1 0 0 1 34.32001 219.23 Tm (we were unable to establish whether this medicine was being administered\ in )Tj 1 0 0 1 34.32001 201.73 Tm (accordance with the prescriber's directions. We also found with some med\ icine that )Tj 1 0 0 1 34.32001 184.23 Tm (was used to treat anxiety that although the home had introduced a stock \ count )Tj 1 0 0 1 34.32001 166.73999 Tm (system, the nursing staff had failed to record the quantity of these tab\ lets that were )Tj 1 0 0 1 34.32001 149.23999 Tm (present in the mobile drug trolley. We attempted to establish whether th\ e )Tj 1 0 0 1 34.32001 131.75 Tm (administration of one of these tablets shown on the administration recor\ ds was the )Tj 1 0 0 1 34.32001 114.25 Tm (only tablet that had been administered in the current medication cycle. \ But due to )Tj 1 0 0 1 34.32001 96.75 Tm (previous poor record keeping and the home not having a having a carry fo\ rward )Tj ET endstream endobj 581 0 obj 5211 endobj 582 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_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 (system in place this proved impossible. We found with some medicine that\ was used )Tj 1 0 0 1 34.32001 761.60004 Tm (to treat epileptic seizures that 55 tablets had been carried forward int\ o the new )Tj 1 0 0 1 34.32001 744.10999 Tm (monthly cycle and the records showed that 31 of these tablets had been a\ dministered. )Tj 1 0 0 1 34.32001 726.60999 Tm (We therefore expected to find 24 tablets remaining however we found 25 t\ ablets. This )Tj 1 0 0 1 34.32001 709.10999 Tm (was the second indication for this person that medicines were being sign\ ed for but not )Tj 1 0 0 1 34.32001 691.62 Tm (actually given.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (With the second person we looked at we found that 500ml of a medicine th\ at was )Tj 1 0 0 1 34.32001 639.13 Tm (used to treat constipation had been carried forward from the previous me\ dication )Tj 1 0 0 1 34.32001 621.63 Tm (cycle. The records showed that 465ml had been used by the home so we exp\ ected )Tj 1 0 0 1 34.32001 604.14001 Tm (find approximately 35 ml remaining in the bottle. We measured the quanti\ ty found in )Tj 1 0 0 1 34.32001 586.64001 Tm (the bottle and this was found to be 200ml. The home acknowledged that th\ is medicine )Tj 1 0 0 1 34.32001 569.14996 Tm (had not been administered correctly. We also found with some tablets use\ d in the )Tj 1 0 0 1 34.32001 551.64996 Tm (treatment of calcium deficiency that 56 tablets had been received and 32\ of these )Tj 1 0 0 1 34.32001 534.14996 Tm (tablets had been administered according to the administration records. W\ e therefore )Tj 1 0 0 1 34.32001 516.65997 Tm (expected to find 24 tablets remaining instead we found 28 tablets still \ present in their )Tj 1 0 0 1 34.32001 499.16 Tm (box)Tj 1 0 0 1 34.32001 481.66998 Tm (\240)Tj 1 0 0 1 34.32001 464.16998 Tm (The third person we looked at identified another failing in the record k\ eeping of )Tj 1 0 0 1 34.32001 446.66998 Tm (medicines. We found that the person concerned had been refusing to take \ a diuretic )Tj 1 0 0 1 34.32001 429.17999 Tm (tablet and as a consequence that nursing staff had been discarding the t\ ablets. We )Tj 1 0 0 1 34.32001 411.67999 Tm (found that the destruction of these tablets had not been recorded and th\ erefore there )Tj 1 0 0 1 34.32001 394.19 Tm (was no audit trail for these tablets.)Tj 1 0 0 1 34.32001 376.69 Tm (\240)Tj 1 0 0 1 34.32001 359.19 Tm (With the fourth person we looked at we found that this person had been p\ rescribed an )Tj 1 0 0 1 34.32001 341.70001 Tm (analgesic patch the day before the inspection. We found that this patch \ had not been )Tj 1 0 0 1 34.32001 324.20001 Tm (applied because the doctor had directed that only half of the patch was \ to be applied )Tj 1 0 0 1 34.32001 306.70999 Tm (and the nursing staff did not know whether this was safe to do so. The c\ oncern here )Tj 1 0 0 1 34.32001 289.20999 Tm (was that none of the nursing staff had raised their concerns with the do\ ctor or had )Tj 1 0 0 1 34.32001 271.70999 Tm (contacted the manufacturer for advice and the impression the inspector g\ ot was that )Tj 1 0 0 1 34.32001 254.22 Tm (this issue would not been sorted out until the doctor's next visit which\ would be in four )Tj 1 0 0 1 34.32001 236.72 Tm (days time. After direction from the inspector the issue was sorted out .\ )Tj 1 0 0 1 34.32001 219.23 Tm (\240)Tj 1 0 0 1 34.32001 201.73 Tm (We examined the thermometer of the fridge that was being used to store m\ edicines. )Tj 1 0 0 1 34.32001 184.23 Tm (We found that the thermometer was displaying a minimum reading of minus \ ten )Tj 1 0 0 1 34.32001 166.73999 Tm (degrees Celsius, a maximum reading of five degrees Celsius, and an ambie\ nt )Tj 1 0 0 1 34.32001 149.23999 Tm (temperature of minus four degrees Celsius. These reading were clearly ou\ tside the )Tj 1 0 0 1 34.32001 131.75 Tm (accepted temperature range of between two and eight degrees Celsius. We \ examined )Tj 1 0 0 1 34.32001 114.25 Tm (the fridge temperature records as far back as January 2010 and found tha\ t the fridge )Tj 1 0 0 1 34.32001 96.75 Tm (had not been maintained within the expected temperature range over this \ period. )Tj ET endstream endobj 583 0 obj 4525 endobj 584 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 616.22998 w 34.60001 503.28998 m 562.53998 503.28998 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 594.85999 w 33.47 491.47998 m 563.65997 491.47998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 191.84 l S 564.78998 791.10999 m 564.78998 191.84 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 192.92 m 565.87 192.92 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (Worryingly it was seen that the nursing staff were recording temperature\ s that were )Tj 1 0 0 1 34.32001 761.60004 Tm (below zero degrees Celsius and were indicating on the record sheet that \ no action was )Tj 1 0 0 1 34.32001 744.10999 Tm (required. Upon discovering this problem the home managed to obtain a new\ fridge )Tj 1 0 0 1 34.32001 726.60999 Tm (and thermometer by lunchtime. The home now needs to ensure that the medi\ cines )Tj 1 0 0 1 34.32001 709.10999 Tm (stored in this fridge are kept within the expected temperature range. Th\ e home was )Tj 1 0 0 1 34.32001 691.62 Tm (also advised to discard the contents of the fridge and obtain new suppli\ es.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We also found on the day of the inspection that the temperature of the r\ oom where )Tj 1 0 0 1 34.32001 639.13 Tm (the medicines were stored was too hot for the safe storage of medicines.\ The )Tj 1 0 0 1 34.32001 621.63 Tm (temperature was recorded at 27 degrees Celsius and the maximum temperatu\ re )Tj 1 0 0 1 34.32001 604.14001 Tm (stated by manufacturers is 25 degrees Celsius. A member of the nursing s\ taff )Tj 1 0 0 1 34.32001 586.64001 Tm (confirmed that the home was not monitoring this temperature.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (The evidence shows that people's needs are not being met at Holmer Care \ Centre, and )Tj 1 0 0 1 34.32001 534.14996 Tm (we have served Statutory Requirement Notices on the home, requiring them\ to make )Tj 1 0 0 1 34.32001 516.65997 Tm (significant improvements within a short space of time.)Tj 1 0 0 1 34.32001 499.16 Tm (\240)Tj 1 0 0 1 34.32001 481.66998 Tm (On the day of the inspection, we saw some staff talking kindly to people\ and taking )Tj 1 0 0 1 34.32001 464.16998 Tm (time to reassure them. However, on several occasions we saw staff going \ in and out of )Tj 1 0 0 1 34.32001 446.66998 Tm (rooms without talking to the people in them. At lunchtime in one of the \ upstairs )Tj 1 0 0 1 34.32001 429.17999 Tm (lounges, we saw that one person was becoming very distressed. She was cr\ ying out )Tj 1 0 0 1 34.32001 411.67999 Tm (loudly and was very agitated. Several staff came in and out of the room \ without )Tj 1 0 0 1 34.32001 394.19 Tm (acknowledging her distress in any way or making any attempt to calm her \ down. )Tj 1 0 0 1 34.32001 376.69 Tm (When we spoke to the person and reassured her, she quickly became calmer\ . It is not )Tj 1 0 0 1 34.32001 359.19 Tm (acceptable that staff should ignore someone's distress, especially anyon\ e who is as )Tj 1 0 0 1 34.32001 341.70001 Tm (vulnerable as the people who live at Holmer Care Centre.)Tj 1 0 0 1 34.32001 324.20001 Tm (\240)Tj 1 0 0 1 34.32001 306.70999 Tm (We asked care staff how they find out information about the needs of the\ people they )Tj 1 0 0 1 34.32001 289.20999 Tm (are caring for. They told us that they look at a notice board in the sta\ ff area of the )Tj 1 0 0 1 34.32001 271.70999 Tm (home. We saw that this board identified people by name, and included per\ sonal )Tj 1 0 0 1 34.32001 254.22 Tm (details about them. One person had the comment "sore groins" written bes\ ide their )Tj 1 0 0 1 34.32001 236.72 Tm (name. We saw maintenance and kitchen staff passing the notice board. Thi\ s shows a )Tj 1 0 0 1 34.32001 219.23 Tm (basic lack of understanding about people's right to have their privacy a\ nd dignity )Tj 1 0 0 1 34.32001 201.73 Tm (respected. )Tj ET endstream endobj 585 0 obj 6000 endobj 586 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)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 124.35001 w 34.60001 446 m 562.53998 446 l S 1 1 1 RG 22.5 w 32.35001 499.16995 m 564.78998 499.16995 l S 101.85001 w 33.47 434.75 m 563.65997 434.75 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 381.62 l S 564.78998 487.87988 m 564.78998 381.62 l S 32.35001 486.80002 m 564.78998 486.80002 l S 31.27 382.70001 m 565.87 382.70001 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 (The home provides a limited range of activities for people to take part \ in, but these )Tj 1 0 0 1 36.62 409.25 Tm (are not planned to take into account people's individual wishes and pref\ erences. Meals )Tj 1 0 0 1 36.62 391.75998 Tm (provide a nutritious and balanced diet.)Tj 1 0 0 1 28.35001 367.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 274.80002 w 34.60001 219.42998 m 562.53998 219.42998 l S 1 1 1 RG 22.5 w 32.35001 347.82999 m 564.78998 347.82999 l S 253.42998 w 33.47 207.62 m 563.65997 207.62 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 335.44998 m 565.87 335.44998 l S 32.35001 336.53 m 32.35001 78.70001 l S 564.78998 336.53 m 564.78998 78.70001 l S 32.35001 335.44998 m 564.78998 335.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 344.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 319.76999 Tm (People living at the home and the staff were positive about the home's a\ ctivities )Tj 1 0 0 1 36.57001 302.26999 Tm (coordinator, who works part-time for fifteen hours a week. She organises\ activities )Tj 1 0 0 1 36.57001 284.78 Tm (such as baking, quizzes, pet therapy, one to one reading, and memory ses\ sions. )Tj 1 0 0 1 36.57001 267.28 Tm (However we were told that she is the only person with access to the acti\ vities )Tj 1 0 0 1 36.57001 249.78998 Tm (cupboard, and so for most of the time, there are no activities planned o\ r carried out.)Tj 1 0 0 1 36.57001 232.28998 Tm (\240)Tj 1 0 0 1 36.57001 214.78998 Tm (During the inspection, we saw that people were sitting for long periods \ of time with no )Tj 1 0 0 1 36.57001 197.3 Tm (stimulation or staff interaction. We looked in the large downstairs loun\ ge to see what )Tj 1 0 0 1 36.57001 179.8 Tm (books and magazines had been provided by the home. We found a book on so\ ft toy )Tj 1 0 0 1 36.57001 162.31 Tm (making which was stuck to a bookshelf with an unidentifiable sticky subs\ tance, and on )Tj 1 0 0 1 36.57001 144.81 Tm (the same bookshelf we found the crumpled front cover of a gossip magazin\ e and a )Tj 1 0 0 1 36.57001 127.31 Tm (used paper napkin. We saw that there were several 'rummage boxes' in the\ lounge. )Tj 1 0 0 1 36.57001 109.82001 Tm (These contained textured fabrics and other sensory items. However we did\ not see )Tj 1 0 0 1 36.57001 92.32001 Tm (these being used during the day, and we saw that they were not within th\ e reach of )Tj ET endstream endobj 587 0 obj 5160 endobj 588 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_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 (anyone sitting in the lounge. The records did not show that the home pro\ vides )Tj 1 0 0 1 34.32001 761.60004 Tm (individualised activities based on people's interests. The records conta\ ined only a list )Tj 1 0 0 1 34.32001 744.10999 Tm (of some things they like to do, such as flowers and reading. Their wishe\ s and goals in )Tj 1 0 0 1 34.32001 726.60999 Tm (respect of their lifestyle had not been identified, and care plans were \ not based on )Tj 1 0 0 1 34.32001 709.10999 Tm (their interests or what they would like to do and achieve.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (Care plans were extremely brief and sometimes confusing. For example, in\ one )Tj 1 0 0 1 34.32001 656.63 Tm (person's care plan, under the heading 'dates to remember', a date had be\ en written in )Tj 1 0 0 1 34.32001 639.13 Tm (but there was no explanation as to why this was an important date for th\ e person.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Care plans did not show any understanding of the importance of ensuring \ that )Tj 1 0 0 1 34.32001 586.64001 Tm (activities are planned as part of a person-centred approach to care. The\ Alzheimer's )Tj 1 0 0 1 34.32001 569.14996 Tm (Society states that "The uniqueness of each individual with dementia mea\ ns that )Tj 1 0 0 1 34.32001 551.64996 Tm (activities and occupation need to be tailored to their individual needs"\ .)Tj 1 0 0 1 34.32001 534.14996 Tm (\240)Tj 1 0 0 1 34.32001 516.65997 Tm (We asked the Director of Nursing if people living at the home take part \ in any of the )Tj 1 0 0 1 34.32001 499.16 Tm (tasks within the home, such as folding clean laundry or laying tables. S\ he told us that )Tj 1 0 0 1 34.32001 481.66998 Tm (this does not happen. Research has shown that having something meaningfu\ l to do is )Tj 1 0 0 1 34.32001 464.16998 Tm (an important part of quality of life, and this would be a way of providi\ ng activities )Tj 1 0 0 1 34.32001 446.66998 Tm (which people might enjoy and which would make them feel valued.)Tj 1 0 0 1 34.32001 429.17999 Tm (\240)Tj 1 0 0 1 34.32001 411.67999 Tm (We saw that staff are very welcoming to family and friends when they vis\ it, and the )Tj 1 0 0 1 34.32001 394.19 Tm (AQAA states "The rights of citizenship are respected. For example reside\ nts are )Tj 1 0 0 1 34.32001 376.69 Tm (offered the choice to participate in voting.")Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (The Alzheimer's Society has identified access to outside space, such as \ a garden, as )Tj 1 0 0 1 34.32001 324.20001 Tm (having many positive benefits for people with dementia. Holmer Care Cent\ re has a )Tj 1 0 0 1 34.32001 306.70999 Tm (garden space which is planted with colourful flowers. We have visited th\ e home on )Tj 1 0 0 1 34.32001 289.20999 Tm (three occasions over the summer, and have never see anyone out in the ga\ rden, even )Tj 1 0 0 1 34.32001 271.70999 Tm (on hot and dry days. The provider has told us that the The Director of N\ ursing has )Tj 1 0 0 1 34.32001 254.22 Tm (witnessed people in the garden over the summer and one person was seen b\ y the )Tj 1 0 0 1 34.32001 236.72 Tm (Director of Nursing enjoying an afternoon in the garden with their relat\ ive, including )Tj 1 0 0 1 34.32001 219.23 Tm (meals being served under the gazebo on the patio. One person in particul\ ar has )Tj 1 0 0 1 34.32001 201.73 Tm (enjoyed watering the plants - she has identified which areas need wateri\ ng and )Tj 1 0 0 1 34.32001 184.23 Tm (instructed staff on how much to apply. During this process she has remin\ isced about )Tj 1 0 0 1 34.32001 166.73999 Tm (her life on the farm and her own patch of garden as a child. The Directo\ r of Nursing )Tj 1 0 0 1 34.32001 149.23999 Tm (has witnessed this on several occasions during the summer months. A rela\ tive told us )Tj 1 0 0 1 34.32001 131.75 Tm (that the door from the main lounge into the garden is kept locked, and c\ ommented )Tj 1 0 0 1 34.32001 114.25 Tm ("it's a shame that they can't go out, but there's not enough staff to ta\ ke them out".)Tj 1 0 0 1 34.32001 96.75 Tm (\240)Tj ET endstream endobj 589 0 obj 4223 endobj 590 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 598.73999 w 34.60001 512.02997 m 562.53998 512.02997 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 577.37 w 33.47 500.22 m 563.65997 500.22 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 209.34 l S 564.78998 791.10999 m 564.78998 209.34 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 210.40999 m 565.87 210.40999 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 (The home's menus show that there is a wide variety of meals, and they pr\ ovide a )Tj 1 0 0 1 34.32001 761.60004 Tm (nutritious and balanced diet. Two relatives told us that the food is "ve\ ry good - top )Tj 1 0 0 1 34.32001 744.10999 Tm (notch" and "lovely, lots of fresh veg".)Tj 1 0 0 1 34.32001 726.60999 Tm (\240)Tj 1 0 0 1 34.32001 709.10999 Tm (We saw that improvements have been made so that people downstairs can ea\ t in a )Tj 1 0 0 1 34.32001 691.62 Tm (sociable environment. One of the lounges has been made into a dining roo\ m, and we )Tj 1 0 0 1 34.32001 674.12 Tm (saw that people were able to help themselves to vegetables from serving \ dishes on )Tj 1 0 0 1 34.32001 656.63 Tm (the tables. This is good practice, as it encourages people to maintain t\ heir )Tj 1 0 0 1 34.32001 639.13 Tm (independence and gives them more choice.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (Lunchtime service upstairs was not a sociable or peaceful time. People h\ ad their lunch )Tj 1 0 0 1 34.32001 586.64001 Tm (served to them whilst seated in armchairs in the lounges. The food was b\ rought in on )Tj 1 0 0 1 34.32001 569.14996 Tm (trays and placed on small individual tables. There were not enough table\ s for each )Tj 1 0 0 1 34.32001 551.64996 Tm (person, so staff had to keep moving furniture around so that people coul\ d reach their )Tj 1 0 0 1 34.32001 534.14996 Tm (food.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We saw that some people were wearing blue plastic aprons while they were\ eating. )Tj 1 0 0 1 34.32001 481.66998 Tm (This is not a practice which promotes dignity, and the Director of Nursi\ ng assured us )Tj 1 0 0 1 34.32001 464.16998 Tm (that a more appropriate method of protecting people's clothes would be p\ rovided.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We observed staff supporting people to eat. In general staff were kind a\ nd caring and )Tj 1 0 0 1 34.32001 411.67999 Tm (took time to ensure that people were not rushed. However we saw one care\ worker )Tj 1 0 0 1 34.32001 394.19 Tm (get up in the middle of supporting someone with their lunch and hand ove\ r the task to )Tj 1 0 0 1 34.32001 376.69 Tm (another care worker. This is poor practice and shows a lack of respect f\ or the person.)Tj 1 0 0 1 34.32001 359.19 Tm (\240)Tj 1 0 0 1 34.32001 341.70001 Tm (At suppertime, we saw that one person who was in a wheelchair had not be\ en placed )Tj 1 0 0 1 34.32001 324.20001 Tm (so that he could easily eat his food. The supper was soup, and as he lif\ ted and tipped )Tj 1 0 0 1 34.32001 306.70999 Tm (his spoon, the soup was spilled down his clothing. Staff were unaware th\ at this was )Tj 1 0 0 1 34.32001 289.20999 Tm (happening until we pointed it out to them.)Tj 1 0 0 1 34.32001 271.70999 Tm (\240)Tj 1 0 0 1 34.32001 254.22 Tm (During the day of the inspection, we saw many people with food stains on\ their )Tj 1 0 0 1 34.32001 236.72 Tm (clothing, some of which appeared to be dried on. Food debris was not cle\ ared up )Tj 1 0 0 1 34.32001 219.23 Tm (promptly after meals, and we say more about this in the section on Envir\ onment.)Tj ET endstream endobj 591 0 obj 5800 endobj 592 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)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 124.35001 w 34.60001 497 m 562.53998 497 l S 1 1 1 RG 22.5 w 32.35001 550.16998 m 564.78998 550.16998 l S 101.85001 w 33.47 485.75 m 563.65997 485.75 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 432.62 l S 564.78998 538.88 m 564.78998 432.62 l S 32.35001 537.79999 m 564.78998 537.79999 l S 31.27 433.70001 m 565.87 433.70001 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 cannot be fully confident that concerns will be listened to and r\ esolved. Staff )Tj 1 0 0 1 36.62 460.25 Tm (know who to contact if people are abused, but evidence elsewhere in the \ report shows )Tj 1 0 0 1 36.62 442.75998 Tm (that people at the home are at risk of neglect.)Tj 1 0 0 1 28.35001 418.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 325.80002 w 34.60001 244.92998 m 562.53998 244.92998 l S 1 1 1 RG 22.5 w 32.35001 398.82999 m 564.78998 398.82999 l S 304.42999 w 33.47 233.12 m 563.65997 233.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 386.44998 m 565.87 386.44998 l S 32.35001 387.53 m 32.35001 78.70001 l S 564.78998 387.53 m 564.78998 78.70001 l S 32.35001 386.44998 m 564.78998 386.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 395.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 370.76999 Tm (The home has a detailed complaints procedure, which is given to everyone\ who moves )Tj 1 0 0 1 36.57001 353.26999 Tm (into the home. We saw that the complaints procedure is in the Service Us\ er Guide, a )Tj 1 0 0 1 36.57001 335.78 Tm (copy of which is kept by the front door. We looked at the home's records\ of complaints )Tj 1 0 0 1 36.57001 318.28 Tm (received and saw that two had been recorded in the past year. Records sh\ owed that )Tj 1 0 0 1 36.57001 300.78998 Tm (these had been resolved.)Tj 1 0 0 1 36.57001 283.29001 Tm (\240)Tj 1 0 0 1 36.57001 265.79001 Tm (One relative told us that they would feel comfortable raising any concer\ ns with staff at )Tj 1 0 0 1 36.57001 248.3 Tm (the home, but that concerns were not always resolved promptly. They ment\ ioned the )Tj 1 0 0 1 36.57001 230.8 Tm (oppressive heat in one of the upstairs lounges, and said that despite th\ e fact that they )Tj 1 0 0 1 36.57001 213.31 Tm (had raised this as a concern on many occasions, there had been no effect\ ive response. )Tj 1 0 0 1 36.57001 195.81 Tm (We found that the lounge was extremely hot, with the thermometer reading\ 80 )Tj 1 0 0 1 36.57001 178.31 Tm (degrees Fahrenheit.)Tj 1 0 0 1 36.57001 160.81999 Tm (\240)Tj 1 0 0 1 36.57001 143.31999 Tm (One of the ways in which the home can protect people who live there is b\ y ensuring )Tj 1 0 0 1 36.57001 125.83 Tm (that staff know about their role in preventing abuse or neglect. Althoug\ h records )Tj 1 0 0 1 36.57001 108.33 Tm (showed that some staff had been trained, not all staff had received this\ training. The )Tj 1 0 0 1 36.57001 90.83 Tm (Director of Nursing told us that training in this area was due to be pro\ vided soon. )Tj ET endstream endobj 593 0 obj 2378 endobj 594 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 266.32001 w 34.60001 678.25 m 562.53998 678.25 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 244.93999 w 33.47 666.44 m 563.65997 666.44 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 541.76001 l S 564.78998 791.10999 m 564.78998 541.76001 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 542.83997 m 565.87 542.83997 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (However, staff knew how to report any concerns about possible abuse or n\ eglect. )Tj 1 0 0 1 34.32001 761.60004 Tm (Whilst staff know how to report their concerns about possible abuse or n\ eglect, we )Tj 1 0 0 1 34.32001 744.10999 Tm (were concerned that they had failed to recognise potential neglect in so\ me )Tj 1 0 0 1 34.32001 726.60999 Tm (circumstances. We have talked about these issues in the report in the se\ ction on )Tj 1 0 0 1 34.32001 709.10999 Tm (Health and Personal Care.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (During the past year, the Local Authority has made us aware of incidents\ which they )Tj 1 0 0 1 34.32001 656.63 Tm (have investigated under their procedures for protecting vulnerable adult\ s. Some of )Tj 1 0 0 1 34.32001 639.13 Tm (these incidents had not been reported by the home as they should have be\ en.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (One of the ways in which people can be protected from the risk of neglec\ t or abuse is )Tj 1 0 0 1 34.32001 586.64001 Tm (to ensure that unsuitable staff are not employed. We saw that staff recr\ uitment )Tj 1 0 0 1 34.32001 569.14996 Tm (procedures at the home are robust, and help to protect people by making \ sure that )Tj 1 0 0 1 34.32001 551.64996 Tm (only suitable staff are employed.)Tj ET endstream endobj 595 0 obj 5838 endobj 596 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Environment )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 104.25 w 32.32001 661.38 m 562.52997 661.38 l S 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.64996 697.63 l S 1 1 1 RG 68 w 31.2 644.38 m 563.64996 644.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 679.5 m 565.84998 679.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 679.5 m 565.84998 679.5 l S 28.99001 609.25 m 565.84998 609.25 l S 30.07001 716.82996 m 30.07001 608.16998 l S 564.77997 716.82996 m 564.77997 608.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People stay in a safe and well-maintained home that is homely, clean, pl\ easant and )Tj 1 0 0 1 35.5 685.57001 Tm (hygienic. )Tj 1 0 0 1 35.5 666.32001 Tm (People stay in a home that has enough space and facilities for them to l\ ead the life )Tj 1 0 0 1 35.5 649.32001 Tm (they choose and to meet their needs. The home makes sure they have the r\ ight )Tj 1 0 0 1 35.5 632.32001 Tm (specialist equipment that encourages and promotes their independence. Th\ eir room )Tj 1 0 0 1 35.5 615.32001 Tm (feels like their own, it is comfortable and they feel safe when they use\ it.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 591 Tm <0003>Tj 1 0 0 1 28.35001 569 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 569 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 546.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 106.85001 w 34.60001 488.73999 m 562.53998 488.73999 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 84.36 w 33.47 477.5 m 563.65997 477.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 433.12 l S 564.78998 521.88 m 564.78998 433.12 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 434.19 m 565.87 434.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (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 (Holmer Care Centre does not provide a safe or homely environment for peo\ ple, and )Tj 1 0 0 1 36.62 443.25 Tm (the home is not kept clean and hygienic. )Tj 1 0 0 1 28.35001 418.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 326.30002 w 34.60001 245.17 m 562.53998 245.17 l S 1 1 1 RG 22.5 w 32.35001 399.31998 m 564.78998 399.31998 l S 304.92999 w 33.47 233.36 m 563.65997 233.36 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 386.94998 m 565.87 386.94998 l S 32.35001 388.03 m 32.35001 78.70001 l S 564.78998 388.03 m 564.78998 78.70001 l S 32.35001 386.94998 m 564.78998 386.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 396.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 371.26999 Tm (Holmer Care Centre is a specialist nursing home for the care of people w\ ith a )Tj 1 0 0 1 36.57001 353.76999 Tm (dementia illness. As such, we would expect the home to provide a stimula\ ting and )Tj 1 0 0 1 36.57001 336.26999 Tm (safe environment for the people who live there. Unfortunately this is no\ t the case.)Tj 1 0 0 1 36.57001 318.78 Tm (\240)Tj 1 0 0 1 36.57001 301.28 Tm (The home is a large building with people accommodated on two floors. The\ re are )Tj 1 0 0 1 36.57001 283.79001 Tm (some long corridors which do not provide visual cues to help people orie\ ntate )Tj 1 0 0 1 36.57001 266.29001 Tm (themselves around the home. At one of our previous inspections, we had s\ uggested )Tj 1 0 0 1 36.57001 248.78998 Tm (that visual cues might help people to identify important rooms such as t\ oilets. We saw )Tj 1 0 0 1 36.57001 231.3 Tm (that toilet doors have been painted red, and the Director of Nursing tol\ d us that this )Tj 1 0 0 1 36.57001 213.8 Tm (had been done to help people find the toilets easily. We checked one of \ the doors )Tj 1 0 0 1 36.57001 196.31 Tm (which had been painted red. It was locked and a member of staff told us \ that it was )Tj 1 0 0 1 36.57001 178.81 Tm (always kept locked because equipment was stored there. This could be ver\ y confusing )Tj 1 0 0 1 36.57001 161.31 Tm (for someone with dementia. We were surprised to find that there was actu\ ally no toilet )Tj 1 0 0 1 36.57001 143.81999 Tm (in the room when it was eventually unlocked, therefore this would have b\ een even )Tj 1 0 0 1 36.57001 126.32001 Tm (more confusing for anyone who had managed to get into the room.)Tj 1 0 0 1 36.57001 108.83 Tm (\240)Tj 1 0 0 1 36.57001 91.33 Tm (There are four lounges at the home, one of which has been designated as \ the 'quiet' )Tj ET endstream endobj 597 0 obj 4837 endobj 598 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_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 (lounge. There is a dining room on the ground floor, and the Director of \ Nursing told us )Tj 1 0 0 1 34.32001 761.60004 Tm (that there are plans to make one of the upstairs lounges into a dining a\ rea.)Tj 1 0 0 1 34.32001 744.10999 Tm (\240)Tj 1 0 0 1 34.32001 726.60999 Tm (We found that the lounges in general did not provide a stimulating envir\ onment for )Tj 1 0 0 1 34.32001 709.10999 Tm (people. In one lounge the large television was on with the sound turned \ down, which )Tj 1 0 0 1 34.32001 691.62 Tm (again could have confused people with dementia. In the evening, loud pop\ music was )Tj 1 0 0 1 34.32001 674.12 Tm (playing in the large lounge downstairs, and one person was distressed an\ d asked us to )Tj 1 0 0 1 34.32001 656.63 Tm (turn it off.)Tj 1 0 0 1 34.32001 639.13 Tm (\240)Tj 1 0 0 1 34.32001 621.63 Tm (At the previous two inspections of the home in July 2010, we had raised \ serious )Tj 1 0 0 1 34.32001 604.14001 Tm (concerns about cleanliness and infection control within the home. We had\ made )Tj 1 0 0 1 34.32001 586.64001 Tm (requirements that the home must ensure that the environment is clean and\ hygienic.)Tj 1 0 0 1 34.32001 569.14996 Tm (\240)Tj 1 0 0 1 34.32001 551.64996 Tm (We were very disappointed to find that there was still clear evidence of\ very poor )Tj 1 0 0 1 34.32001 534.14996 Tm (standards of hygiene and infection control.)Tj 1 0 0 1 34.32001 516.65997 Tm (\240)Tj 1 0 0 1 34.32001 499.16 Tm (We found commodes and toilet frames which were visibly dirty with brown \ stains. We )Tj 1 0 0 1 34.32001 481.66998 Tm (found armchairs which were smeared with a brown substance, and a dining \ chair )Tj 1 0 0 1 34.32001 464.16998 Tm (stored in a bathroom which was also smeared with a brown substance.)Tj 1 0 0 1 34.32001 446.66998 Tm (\240)Tj 1 0 0 1 34.32001 429.17999 Tm (We saw food debris on the floors of several of the communal rooms long a\ fter )Tj 1 0 0 1 34.32001 411.67999 Tm (mealtimes. This is a particular risk to people with dementia, as they ma\ y not realise )Tj 1 0 0 1 34.32001 394.19 Tm (that they should not eat these scraps of food. We saw that some of the f\ ood was meat )Tj 1 0 0 1 34.32001 376.69 Tm (products, and as the temperature in at least one of the rooms was 80 deg\ rees )Tj 1 0 0 1 34.32001 359.19 Tm (Fahrenheit, this could pose a risk of food poisoning.)Tj 1 0 0 1 34.32001 341.70001 Tm (\240)Tj 1 0 0 1 34.32001 324.20001 Tm (We saw an open waste bin in the first floor area by the lift. The bin it\ self was visibly )Tj 1 0 0 1 34.32001 306.70999 Tm (dirty, with substances adhering to the base and sides of the bin. The bi\ n was lined )Tj 1 0 0 1 34.32001 289.20999 Tm (with a plastic bag, and contained gloves of the type used for providing \ personal care, )Tj 1 0 0 1 34.32001 271.70999 Tm (a white plastic apron of the type used for providing personal care, soil\ ed tissues and )Tj 1 0 0 1 34.32001 254.22 Tm (food debris.)Tj 1 0 0 1 34.32001 236.72 Tm (\240)Tj 1 0 0 1 34.32001 219.23 Tm (Throughout the home, we saw that clinical waste was not disposed of safe\ ly and in a )Tj 1 0 0 1 34.32001 201.73 Tm (manner which would help to prevent the spread of infection.)Tj 1 0 0 1 34.32001 184.23 Tm (\240)Tj 1 0 0 1 34.32001 166.73999 Tm (At several times during the day inspection, we had seen two people livin\ g at the home )Tj 1 0 0 1 34.32001 149.23999 Tm (sitting on pressure-relieving cushions in the large lounge on the ground\ floor. In the )Tj 1 0 0 1 34.32001 131.75 Tm (evening we checked these cushions, as we had noticed that they appeared \ to be in )Tj 1 0 0 1 34.32001 114.25 Tm (poor condition. One cushion was stained with brown staining to the inter\ ior of the )Tj 1 0 0 1 34.32001 96.75 Tm (cover and to the foam interior. A foul odour was emanating from the seco\ nd cushion, )Tj ET endstream endobj 599 0 obj 1693 endobj 600 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 143.84 w 34.60001 739.47998 m 562.53998 739.47998 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 122.47 w 33.47 727.66998 m 563.65997 727.66998 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 664.22998 l S 564.78998 791.10999 m 564.78998 664.22998 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 665.31 m 565.87 665.31 l S BT /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 it was found to have extensive brown staining to the interior of the\ cover, and the )Tj 1 0 0 1 34.32001 761.60004 Tm (foam interior of the cushion was seen to be heavily stained with a foul \ smelling brown )Tj 1 0 0 1 34.32001 744.10999 Tm (substance. We showed the two cushions to the Director of Nursing, who as\ sured us )Tj 1 0 0 1 34.32001 726.60999 Tm (that the cushions would be disposed of immediately.)Tj 1 0 0 1 34.32001 709.10999 Tm (\240)Tj 1 0 0 1 34.32001 691.62 Tm (We have served a Statutory Requirement Notice on the home requiring them\ to make )Tj 1 0 0 1 34.32001 674.12 Tm (sure that the home is kept clean and hygienic.)Tj ET endstream endobj 601 0 obj 5929 endobj 602 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)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 106.85001 w 34.60001 488.73999 m 562.53998 488.73999 l S 1 1 1 RG 22.5 w 32.35001 533.16998 m 564.78998 533.16998 l S 84.36 w 33.47 477.5 m 563.65997 477.5 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 520.79999 m 565.87 520.79999 l S 32.35001 521.88 m 32.35001 433.12 l S 564.78998 521.88 m 564.78998 433.12 l S 32.35001 520.79999 m 564.78998 520.79999 l S 31.27 434.19 m 565.87 434.19 l S BT /T1_0 12 Tf 1 0 0 1 35.5 529.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 505.12 Tm (adequate)Tj 0 Tr 1 0 0 1 319.39999 505.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 487.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 460.75 Tm (Staff do not always receive the training they need to provide support fo\ r people living )Tj 1 0 0 1 36.62 443.25 Tm (at the home. There are not enough staff on duty to meet people's needs.)Tj 1 0 0 1 28.35001 418.50998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 326.30002 w 34.60001 245.17 m 562.53998 245.17 l S 1 1 1 RG 22.5 w 32.35001 399.31998 m 564.78998 399.31998 l S 304.92999 w 33.47 233.36 m 563.65997 233.36 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 386.94998 m 565.87 386.94998 l S 32.35001 388.03 m 32.35001 78.70001 l S 564.78998 388.03 m 564.78998 78.70001 l S 32.35001 386.94998 m 564.78998 386.94998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 396.00998 Tm (Evidence:)Tj 1 0 0 1 36.57001 371.26999 Tm (We spoke to relatives of people living at Holmer Care Centre, and they w\ ere very )Tj 1 0 0 1 36.57001 353.76999 Tm (positive about the staff at the home, describing most of them as "kind",\ "helpful" and )Tj 1 0 0 1 36.57001 336.26999 Tm ("lovely". However, one relative told us that "some staff don't seem to h\ ave the )Tj 1 0 0 1 36.57001 318.78 Tm (patience". Another told us that some staff, who do not have English as t\ heir first )Tj 1 0 0 1 36.57001 301.28 Tm (language, do not always find it easy to understand what is being said to\ them. During )Tj 1 0 0 1 36.57001 283.79001 Tm (the inspection, we saw that staff were kind and caring when they support\ ed people, )Tj 1 0 0 1 36.57001 266.29001 Tm (and all the staff we spoke to were able to communicate with us.)Tj 1 0 0 1 36.57001 248.78998 Tm (\240)Tj 1 0 0 1 36.57001 231.3 Tm (Although we were informed that all the staff working at the home had bee\ n trained in )Tj 1 0 0 1 36.57001 213.8 Tm (dementia care, the whole culture of the home does not promote person-cen\ tred care. )Tj 1 0 0 1 36.57001 196.31 Tm (The Alzheimer's Society describes person-centred care as "Instead of tre\ ating the )Tj 1 0 0 1 36.57001 178.81 Tm (person as a collection of symptoms and behaviours to be controlled, pers\ on-centred )Tj 1 0 0 1 36.57001 161.31 Tm (care considers the whole person, taking into account each individual's u\ nique qualities, )Tj 1 0 0 1 36.57001 143.81999 Tm (abilities, interests, preferences and needs". We saw some staff behaving\ in a way )Tj 1 0 0 1 36.57001 126.32001 Tm (which made us think that they did not understand the principles of perso\ n-centred )Tj 1 0 0 1 36.57001 108.83 Tm (care. For example, a staff member passed someone their pudding at luncht\ ime, and )Tj 1 0 0 1 36.57001 91.33 Tm (said to them "pudding, pudding, pudding" in a childish voice. As describ\ ed in the )Tj ET endstream endobj 603 0 obj 3255 endobj 604 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 406.28 w 34.60001 608.26001 m 562.53998 608.26001 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 384.91 w 33.47 596.45001 m 563.65997 596.45001 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 401.78998 l S 564.78998 791.10999 m 564.78998 401.78998 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 402.87 m 565.87 402.87 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (section on Health and Personal Care, we saw staff ignoring someone who w\ as clearly )Tj 1 0 0 1 34.32001 761.60004 Tm (distressed. It was sometimes difficult to reconcile the caring and kind \ approach of staff )Tj 1 0 0 1 34.32001 744.10999 Tm (to individual people with the seemingly uncaring and unkind way in which\ people were )Tj 1 0 0 1 34.32001 726.60999 Tm (left in a state of distress or did not have a dressing applied when nece\ ssary \(as )Tj 1 0 0 1 34.32001 709.10999 Tm (described in the section on Health and Personal Care\). We say more abou\ t staff )Tj 1 0 0 1 34.32001 691.62 Tm (attitudes in the section on Management and Administration.)Tj 1 0 0 1 34.32001 674.12 Tm (\240)Tj 1 0 0 1 34.32001 656.63 Tm (We checked to see if staff had been recruited safely, and we found that \ the home's )Tj 1 0 0 1 34.32001 639.13 Tm (recruitment procedures ensure that only suitable staff are employed.)Tj 1 0 0 1 34.32001 621.63 Tm (\240)Tj 1 0 0 1 34.32001 604.14001 Tm (We continue to have serious concerns about staffing levels at the home. \ The home )Tj 1 0 0 1 34.32001 586.64001 Tm (uses a Staffing Level Analysis to help them determine the level of staff\ ing required. )Tj 1 0 0 1 34.32001 569.14996 Tm (This categorises the dependency levels of each person living at the home\ and uses a )Tj 1 0 0 1 34.32001 551.64996 Tm (calculation to find out how many staff are needed. We saw that the Staff\ ing Level )Tj 1 0 0 1 34.32001 534.14996 Tm (Analysis showed that everyone living at the home had been assessed as ha\ ving a )Tj 1 0 0 1 34.32001 516.65997 Tm (medium dependency level. The home's own records show that sixteen people\ living at )Tj 1 0 0 1 34.32001 499.16 Tm (the home have been assessed as being "immobile", so it is hard to see ho\ w these )Tj 1 0 0 1 34.32001 481.66998 Tm (people can only have medium dependency.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (We have not been able to find out how the home assesses the dependency l\ evels of )Tj 1 0 0 1 34.32001 429.17999 Tm (each person, but the evidence throughout the inspection shows that there\ are not )Tj 1 0 0 1 34.32001 411.67999 Tm (enough staff to meet people's individual needs.)Tj ET endstream endobj 605 0 obj 5846 endobj 606 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 1 1 1 RG 13.60001 w 29.55 794.84998 m 566.92999 794.84998 l S 0 0 0 RG 0.5 w BT /T1_0 16 Tf 2 Tr 1 0 0 1 29.55 785.57001 Tm (Management and administration )Tj /T1_0 10 Tf 1 0 0 1 29.55 766 Tm (\240)Tj /T1_0 12 Tf 1 0 0 1 28.35001 747.88995 Tm (These are the outcomes that people )Tj 1 0 0 1 250.50998 747.88995 Tm (staying in care homes)Tj 1 0 0 1 383.42999 747.88995 Tm ( should experience. They )Tj 1 0 0 1 28.35001 730.40002 Tm (reflect the things that people have said are important to them:)Tj /T1_2 5 Tf 0 Tr 1 0 0 1 28.35001 717.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 189.25 w 32.32001 618.88 m 562.52997 618.88 l S 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.64996 672.13 l S 1 1 1 RG 102 w 31.2 576.38 m 563.64996 576.38 l S 0.75294 0.75294 0.75294 RG 2.25 w 28.99001 628.5 m 565.84998 628.5 l S 28.99001 715.75 m 565.84998 715.75 l S 28.99001 628.5 m 565.84998 628.5 l S 28.99001 524.25 m 565.84998 524.25 l S 30.07001 716.82996 m 30.07001 523.16998 l S 564.77997 716.82996 m 564.77997 523.16998 l S BT /T1_0 12 Tf 1 0 0 1 35.5 702.57001 Tm (People have confidence in the care home because it is led and managed ap\ propriately. )Tj 1 0 0 1 35.5 685.57001 Tm (People control their own money and choose how they spend it. If they or \ someone )Tj 1 0 0 1 35.5 668.57001 Tm (close to them cannot manage their money, it is managed by the care home \ in their )Tj 1 0 0 1 35.5 651.57001 Tm (best interests. The environment is safe for people and staff because app\ ropriate health )Tj 1 0 0 1 35.5 634.57001 Tm (and safety practices are carried out.)Tj 1 0 0 1 35.5 615.32001 Tm (People get the right support from the care home because the manager runs\ it )Tj 1 0 0 1 35.5 598.32001 Tm (appropriately with an open approach that makes them feel valued and resp\ ected. The )Tj 1 0 0 1 35.5 581.32001 Tm (people staying at the home are safeguarded because it follows clear fina\ ncial and )Tj 1 0 0 1 35.5 564.32001 Tm (accounting procedures, keeps records appropriately and ensures their sta\ ff understand )Tj 1 0 0 1 35.5 547.32001 Tm (the way things should be done. They get the right care because the staff\ are )Tj 1 0 0 1 35.5 530.32001 Tm (supervised and supported by their managers.)Tj /C2_0 12 Tf 1 0 0 1 28.35001 506 Tm <0003>Tj 1 0 0 1 28.35001 484 Tm <0037004B004C00560003004C00560003005A004B0044005700030053004800520053004F00480003005600570044005C004C0051004A0003004C005100030057004B004C0056000300460044005500480003004B00520050004800030048005B005300480055004C0048005100460048>Tj 1 0 0 1 369.03998 484 Tm <001D>Tj /T1_0 12 Tf 1 0 0 1 28.35001 461.94 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 124.35001 w 34.60001 395 m 562.53998 395 l S 1 1 1 RG 22.5 w 32.35001 448.16998 m 564.78998 448.16998 l S 101.85001 w 33.47 383.75 m 563.65997 383.75 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 435.80002 m 565.87 435.80002 l S 32.35001 436.88 m 32.35001 330.62 l S 564.78998 436.88 m 564.78998 330.62 l S 32.35001 435.80002 m 564.78998 435.80002 l S 31.27 331.70001 m 565.87 331.70001 l S BT /T1_0 12 Tf 1 0 0 1 35.5 444.85999 Tm (Judgement:)Tj 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.16998 420.12 Tm (poor)Tj 0 Tr 1 0 0 1 290.57001 420.12 Tm (quality outcomes in this area. We have )Tj 1 0 0 1 36.62 402.62 Tm (made this judgement using a range of evidence, including a visit to this\ service.)Tj 1 0 0 1 36.62 375.75 Tm (The home lacks direction and leadership, and this has had a negative imp\ act on )Tj 1 0 0 1 36.62 358.25 Tm (people living at the home. Some aspects of health and safety are not ade\ quately )Tj 1 0 0 1 36.62 340.75998 Tm (managed.)Tj 1 0 0 1 28.35001 316.00998 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 223.8 w 34.60001 193.92999 m 562.53998 193.92999 l S 1 1 1 RG 22.5 w 32.35001 296.82999 m 564.78998 296.82999 l S 202.42998 w 33.47 182.12 m 563.65997 182.12 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 284.44998 m 565.87 284.44998 l S 32.35001 285.53 m 32.35001 78.70001 l S 564.78998 285.53 m 564.78998 78.70001 l S 32.35001 284.44998 m 564.78998 284.44998 l S 31.27 79.78 m 565.87 79.78 l S BT /T1_0 12 Tf 1 0 0 1 35.5 293.51999 Tm (Evidence:)Tj 1 0 0 1 36.57001 268.76999 Tm (The two recent random inspections and this inspection have raised seriou\ s concerns )Tj 1 0 0 1 36.57001 251.26999 Tm (about the management of the home. The home has been without a registered\ )Tj 1 0 0 1 36.57001 233.78 Tm (manager since April 2010. However, many of the areas of concern have obv\ iously )Tj 1 0 0 1 36.57001 216.28 Tm (been ongoing for a long time.)Tj 1 0 0 1 36.57001 198.78998 Tm (\240)Tj 1 0 0 1 36.57001 181.28998 Tm (It is the provider's responsibility to ensure that the home is managed i\ n a way which )Tj 1 0 0 1 36.57001 163.78999 Tm (promotes and protects the rights of the people who live there. Providers\ are required )Tj 1 0 0 1 36.57001 146.3 Tm (to carry out monthly visits to ensure that the home is providing a safe \ standard of )Tj 1 0 0 1 36.57001 128.8 Tm (care. We saw that these monthly visits had been carried out and had been\ recorded. )Tj 1 0 0 1 36.57001 111.31 Tm (However, the evidence of the inspection showed that the home is not prov\ iding a safe )Tj 1 0 0 1 36.57001 93.81 Tm (standard of care and that standards have deteriorated significantly over\ a period of )Tj ET endstream endobj 607 0 obj 3218 endobj 608 0 obj<>stream 0.75294 0.75294 0.75294 RG 1 i 20.58 w 10 M 0 j 0 J []0 d 28.35001 56.81 m 566.92999 56.81 l S 0 0 0 rg 0 0 0 RG 0.5 w BT /T1_0 11 Tf 0 Tc 0 Tw 0 Ts 100 Tz 2 Tr 1 0 0 1 31.2 53.03999 Tm (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 1 0 0 1 456.45999 52.03999 Tm (\240)Tj /T1_0 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 (36)Tj /T1_1 10 Tf 0 Tr 1 0 0 1 28.35001 37.61 Tm (\240)Tj ET 0.99608 0.9451 0.76077 RG 458.76999 w 34.60001 582.01996 m 562.53998 582.01996 l S 1 1 1 RG 22.5 w 32.35001 802.40997 m 564.78998 802.40997 l S 437.39999 w 33.47 570.20996 m 563.65997 570.20996 l S 0.75294 0.75294 0.75294 RG 2.25 w 31.27 790.02997 m 565.87 790.02997 l S 32.35001 791.10999 m 32.35001 349.31 l S 564.78998 791.10999 m 564.78998 349.31 l S 32.35001 790.02997 m 564.78998 790.02997 l S 31.27 350.38 m 565.87 350.38 l S BT /T1_0 12 Tf 1 0 0 1 35.5 799.08997 Tm (Evidence:)Tj 1 0 0 1 34.32001 779.10004 Tm (time.)Tj 1 0 0 1 34.32001 761.60004 Tm (\240)Tj 1 0 0 1 34.32001 744.10999 Tm (There are interim management measures in place at the home, but these do\ not )Tj 1 0 0 1 34.32001 726.60999 Tm (appear to be effective, as there has not been any improvement in some ke\ y areas )Tj 1 0 0 1 34.32001 709.10999 Tm (which we identified in our two inspections in July 2010.)Tj 1 0 0 1 34.32001 691.62 Tm (\240)Tj 1 0 0 1 34.32001 674.12 Tm (The home has shown that health and safety issues are not well managed. W\ e have )Tj 1 0 0 1 34.32001 656.63 Tm (highlighted our concerns about hygiene standards and poor infection cont\ rol )Tj 1 0 0 1 34.32001 639.13 Tm (measures. We found other areas of concern, such as the lagging around ho\ t water )Tj 1 0 0 1 34.32001 621.63 Tm (pipes in communal areas, which was torn with parts missing. This could p\ lace people )Tj 1 0 0 1 34.32001 604.14001 Tm (at risk of being burned.)Tj 1 0 0 1 34.32001 586.64001 Tm (\240)Tj 1 0 0 1 34.32001 569.14996 Tm (We have serious concerns about some of the shortfalls which we have foun\ d at Holmer )Tj 1 0 0 1 34.32001 551.64996 Tm (Care Centre. Some of them show a lack of understanding of what constitut\ es good )Tj 1 0 0 1 34.32001 534.14996 Tm (care for people with dementia. Some of them show a disregard for people'\ s basic )Tj 1 0 0 1 34.32001 516.65997 Tm (rights as human beings. When added together, they give a picture of a se\ rvice which )Tj 1 0 0 1 34.32001 499.16 Tm (poses a very high risk of poor outcomes for the vulnerable people who li\ ve at the )Tj 1 0 0 1 34.32001 481.66998 Tm (home.)Tj 1 0 0 1 34.32001 464.16998 Tm (\240)Tj 1 0 0 1 34.32001 446.66998 Tm (The Local Authority and Herefordshire Primary Care Trust have made us aw\ are of their )Tj 1 0 0 1 34.32001 429.17999 Tm (own concerns about the service, and we are working closely with them und\ er the local )Tj 1 0 0 1 34.32001 411.67999 Tm (procedures for safeguarding vulnerable adults.)Tj 1 0 0 1 34.32001 394.19 Tm (\240)Tj 1 0 0 1 34.32001 376.69 Tm (We will continue to monitor the home closely and will take legal action \ if necessary to )Tj 1 0 0 1 34.32001 359.19 Tm (protect the people who live there.)Tj ET endstream endobj 609 0 obj 3690 endobj 610 0 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 (30)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 (36)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 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