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*{;i?})2De+1>pq C3pj4ZjL&y n36#NkStY TUB5(b}Bi'Bhn>9ZZ^ gZv5v7Z4M*ď$h")`]Ao/>?ö9[[kW_ 5=[X$ 5čL/soƥ_GNK _cZDo hW4PǧhvhB +gOȕ |I_^s<1b+Ѩy=_aPqYʞ"p=tiC!uG ,J)0p] (TR|cƷ4»B/׾*ьůI-?诫8?ۯwW |#xwúϊMCB.񵥾[kY]G%u-c_XZ Q>stream 0 J q 538.5 0 0 61.5 28.35 14.2 cm /img0 Do Q 0.98431 0.78824 0.08627 RG 135.75 w 24.07 742.4 m 558.15 742.4 l S 0.001 w [] 0 d 2.25 w 20.74 812.53 m 561.48 812.53 l S 0.001 w [] 0 d [] 0 d 2.25 w 20.74 674.53 m 561.48 674.53 l S 0.001 w [] 0 d [] 0 d 2.25 w 21.82 813.61 m 21.82 673.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 560.4 813.61 m 560.4 673.45 l S 0.001 w [] 0 d q 191.25 0 0 117.75 28.35 685.65 cm /img1 Do Q /F1 12 Tf 0.6 0.6 0.6 rg BT 1 0 0 1 136.35 656.27 Tm (,QVSHFWLQJIRUEHWWHUOLYHV)Tj ET /F1 28 Tf 0 0 0 rg BT 1 0 0 1 147.05 596.27 Tm (.H\\LQVSHFWLRQUHSRUW)Tj ET 20.58 w 27.33 552.19 m 557.15 552.19 l S 0.001 w /F2 24 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 504.5 Tm (Care homes for older people)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 6 Tf BT 1 0 0 1 28.35 493.46 Tm ()Tj ET /F1 6 Tf BT 1 0 0 1 28.35 486.22 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 472.44 m 160.38 472.44 l S 0.001 w 1 1 1 RG 20.58 w 162.63 472.44 m 563.65 472.44 l S 0.001 w 0.99608 0.9451 0.76078 RG 73.32 w 31.2 423.24 m 160.38 423.24 l S 0.001 w 1 1 1 RG 73.32 w 162.63 423.24 m 563.65 423.24 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 461.02 m 565.85 461.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 483.85 m 565.85 483.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 461.02 m 565.85 461.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 385.45 m 565.85 385.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 484.93 m 30.07 384.38 l S 0.001 w [] 0 d [] 0 d 2.25 w 161.5 484.93 m 161.5 384.38 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 484.93 m 564.78 384.38 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 467.67 Tm (Name:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 165.48 467.67 Tm (Abbey Grange)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 444.84 Tm (Address:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 165.48 444.84 Tm (47 Venns Lane )Tj ET /F2 12 Tf BT 1 0 0 1 165.48 427.26 Tm (Hereford)Tj ET /F2 12 Tf BT 1 0 0 1 165.48 409.68 Tm (Herefordshire)Tj ET /F2 12 Tf BT 1 0 0 1 165.48 392.1 Tm (HR1 1DT)Tj ET /F3 10 Tf BT 1 0 0 1 28.35 373.2 Tm ()Tj ET /F3 10 Tf BT 1 0 0 1 28.35 356.2 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 336.66 m 358.95 336.66 l S 0.001 w 1 1 1 RG 20.58 w 361.2 336.66 m 565.9 336.66 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 348.08 m 568.1 348.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 325.25 m 568.1 325.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 349.15 m 30.07 324.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 360.07 349.15 m 360.07 324.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 349.15 m 567.02 324.17 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 331.89 Tm (The quality rating for this )Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 191.92 331.89 Tm (care home)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 255.59 331.89 Tm ( is:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 399.3 331.89 Tm (zero star poor service)Tj ET /F3 10 Tf BT 1 0 0 1 28.35 312.99 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 293.94 Tm (A quality rating is our assessment of how well a care home, agency or scheme is )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 276.94 Tm (meeting the needs of the people who use it.)Tj ET /F2 12 Tf BT 1 0 0 1 295.2 276.94 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 303.65 276.94 Tm (We give a quality rating following a full )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 259.94 Tm (assessment of the service.)Tj ET /F2 12 Tf BT 1 0 0 1 189.22 259.94 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 197.67 259.94 Tm (We call this a key inspection.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 242.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 225.46 m 315.25 225.46 l S 0.001 w 20.58 w 317.5 225.46 m 565.9 225.46 l S 0.001 w 1 1 1 RG 20.58 w 317.5 202.63 m 346.55 202.63 l S 0.001 w 20.58 w 348.8 202.63 m 377.9 202.63 l S 0.001 w 20.58 w 380.15 202.63 m 409.2 202.63 l S 0.001 w 20.58 w 411.45 202.63 m 440.55 202.63 l S 0.001 w 20.58 w 442.8 202.63 m 471.9 202.63 l S 0.001 w 20.58 w 474.15 202.63 m 503.2 202.63 l S 0.001 w 20.58 w 505.45 202.63 m 534.55 202.63 l S 0.001 w 20.58 w 536.8 202.63 m 565.9 202.63 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 214.04 m 568.1 214.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 236.87 m 568.1 236.87 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 214.04 m 568.1 214.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 191.21 m 568.1 191.21 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 237.95 m 30.07 190.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 316.37 237.95 m 316.37 190.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 347.67 215.12 m 347.67 190.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 379.02 215.12 m 379.02 190.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 410.32 215.12 m 410.32 190.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 441.67 215.12 m 441.67 190.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 473.02 215.12 m 473.02 190.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 504.32 215.12 m 504.32 190.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 535.67 215.12 m 535.67 190.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 237.95 m 567.02 190.13 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 220.69 Tm (Lead inspector:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 320.35 220.69 Tm (Date:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 197.86 Tm (Denise Reynolds)Tj ET /F2 12 Tf BT 1 0 0 1 329.63 197.86 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 360.95 197.86 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 392.28 197.86 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 423.61 197.86 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 454.95 197.86 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 486.28 197.86 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 517.6 197.86 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 548.96 197.86 Tm (9)Tj ET /F3 10 Tf BT 1 0 0 1 28.35 178.96 Tm ()Tj ET /F3 10 Tf BT 1 0 0 1 28.35 161.96 Tm ()Tj ET /F1 10 Tf BT 1 0 0 1 297.64 144.96 Tm ()Tj ET /F1 10 Tf BT 1 0 0 1 297.64 132.89 Tm ()Tj ET /F1 10 Tf BT 1 0 0 1 297.64 120.82 Tm ()Tj ET endstream endobj 6 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/XObject<>>>/MediaBox[0 0 595 842]>> endobj 10 0 obj<>>> endobj 11 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 485.42 30.79 Tm (Page)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 515.95 30.79 Tm (2)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 523.58 30.79 Tm ( of )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 541.88 30.79 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 10 Tf BT 1 0 0 1 297.64 803.65 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 787.03 Tm (This is a report of an inspection where we looked at how well this )Tj ET /F2 12 Tf BT 1 0 0 1 428.32 787.03 Tm (care home is meeting )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 769.53 Tm (the needs of people who use it.)Tj ET /F2 12 Tf BT 1 0 0 1 226.66 769.53 Tm (There is a summary of what we think this service does )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 752.03 Tm (well, what they have improved on and, where it applies, what they need to do better.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 734.54 Tm (We use the national minimum standards to describe the outcomes that people should )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 717.04 Tm (experience.)Tj ET /F2 12 Tf BT 1 0 0 1 106.61 717.04 Tm (National minimum standards are written by the Department of Health for )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 699.54 Tm (each type of care service.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 679.55 Tm (After the summary there is more detail about our findings. The following table explains )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 662.05 Tm (what you will see under each outcome area.)Tj ET [] 0 d 0.5 w 0 0 0 RG 22.69 653.87 m 572.15 653.87 l S 0.001 w [] 0 d [] 0 d 0.5 w 22.69 320.23 m 572.15 320.23 l S 0.001 w [] 0 d [] 0 d 0.5 w 22.7 653.87 m 22.7 320.23 l S 0.001 w [] 0 d [] 0 d 0.5 w 572.15 653.87 m 572.15 320.23 l S 0.001 w [] 0 d /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 640.57 Tm (Outcome area \(for example )Tj ET 0 0 0 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 173.59 640.57 Tm (Choice of home\))Tj ET 0 0 0 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 610.27 Tm (These are the outcomes that people )Tj ET 0 0 0 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 216.34 610.27 Tm (staying in care homes should experience.)Tj ET 0 0 0 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 435.79 610.27 Tm (They reflect the things )Tj ET 0 0 0 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 598.12 Tm (that people have said are important to them:)Tj ET 0 0 0 RG 0.001 w 0 Tr 1 0.9451 0.76078 RG 82.23 w 30.6 533.38 m 562.45 533.38 l S 0.001 w 1 1 1 RG 39.99 w 29.47 513.38 m 563.57 513.38 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 27.27 534.5 m 565.77 534.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.27 576.74 m 565.77 576.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.27 534.5 m 565.77 534.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.27 492.26 m 565.77 492.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.35 577.82 m 28.35 491.18 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.7 577.82 m 564.7 491.18 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.87 561.06 Tm (This box tells you the outcomes that we will always inspect against when we do a key )Tj ET /F2 12 Tf BT 1 0 0 1 34.87 543.56 Tm (inspection)Tj ET /F2 10 Tf BT 1 0 0 1 95.78 543.56 Tm (.)Tj ET /F2 12 Tf BT 1 0 0 1 34.87 518.82 Tm (This box tells you any additional outcomes that we may inspect against when we do a )Tj ET /F2 12 Tf BT 1 0 0 1 34.87 501.32 Tm (key inspection.)Tj ET /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 461.81 Tm (This is what people )Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 131.32 461.81 Tm (staying in this care home experience:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 28.35 424.65 Tm (Judgement:)Tj ET 1 0.9451 0.76078 RG 39.99 w 30.6 393.35 m 562.45 393.35 l S 0.001 w 1 1 1 RG 39.99 w 29.47 394.47 m 563.57 394.47 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 27.27 415.59 m 565.77 415.59 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.27 373.35 m 565.77 373.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.35 416.67 m 28.35 372.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.7 416.67 m 564.7 372.27 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.87 399.91 Tm (This box tells you our opinion of what we have looked at in this outcome area.)Tj ET /F2 12 Tf BT 1 0 0 1 517.79 399.91 Tm (We )Tj ET /F2 12 Tf BT 1 0 0 1 34.87 382.41 Tm (will say whether it is excellent, good, adequate or poor.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 356.54 Tm (Evidence:)Tj ET 1 0.9451 0.76078 RG 22.5 w 30.6 333.98 m 562.45 333.98 l S 0.001 w 1 1 1 RG 22.5 w 29.47 335.11 m 563.57 335.11 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 27.27 347.48 m 565.77 347.48 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.27 322.73 m 565.77 322.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.35 348.55 m 28.35 321.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.7 348.55 m 564.7 321.65 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.87 331.79 Tm (This box describes the information we used to come to our judgement.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 285.18 Tm (Copies of the)Tj ET /F2 12 Tf BT 1 0 0 1 111.71 285.18 Tm (National Minimum Standards )Tj ET /F2 12 Tf BT 1 0 0 1 290.49 285.18 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 302.34 285.18 Tm (Care Homes for Older People)Tj ET /F2 12 Tf BT 1 0 0 1 477.18 285.18 Tm ( can be found )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 267.68 Tm (at www.dh.gov.uk or bought from The Stationery Office \(TSO\) PO Box 29, St Crispins, )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 250.18 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 232.69 Tm (Stationery Office is also available: )Tj ET /F2 12 Tf 0 0 1 rg BT 1 0 0 1 238.73 232.69 Tm (www.tso.co.uk/bookshop)Tj ET /F2 12 Tf 0 0 0 rg BT 1 0 0 1 28.35 192.7 Tm (The Commission for Social Care Inspection aims to:)Tj ET /F4 12 Tf BT 1 0 0 1 46.35 172.7 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 64.35 172.7 Tm (Put the people who use social care first)Tj ET /F4 12 Tf BT 1 0 0 1 46.35 155.06 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 64.35 155.06 Tm (Improve services and stamp out bad practice)Tj ET /F4 12 Tf BT 1 0 0 1 46.35 137.42 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 64.35 137.42 Tm (Be an expert voice on social care)Tj ET /F4 12 Tf BT 1 0 0 1 46.35 119.78 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 64.35 119.78 Tm (Practise what we preach in our own organisation)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 79.64 Tm (Our duty to regulate social care services is set out in the Care Standards Act 2000.)Tj ET endstream endobj 12 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 13 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 485.42 30.79 Tm (Page)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 515.95 30.79 Tm (3)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 523.58 30.79 Tm ( of )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 541.88 30.79 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 14 Tf BT 1 0 0 1 28.35 795.65 Tm (5HDGHU,QIRUPDWLRQ)Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 28.35 774.22 m 224.05 774.22 l S 0.001 w 1 1 1 RG 20.58 w 226.3 774.22 m 567 774.22 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 28.35 751.39 m 224.05 751.39 l S 0.001 w 1 1 1 RG 20.58 w 226.3 751.39 m 567 751.39 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 28.35 728.56 m 224.05 728.56 l S 0.001 w 1 1 1 RG 20.58 w 226.3 728.56 m 567 728.56 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 28.35 705.73 m 224.05 705.73 l S 0.001 w 1 1 1 RG 20.58 w 226.3 705.73 m 567 705.73 l S 0.001 w 0.99608 0.9451 0.76078 RG 151.8 w 28.35 617.29 m 224.05 617.29 l S 0.001 w 1 1 1 RG 151.8 w 226.3 617.29 m 567 617.29 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 28.35 528.85 m 224.05 528.85 l S 0.001 w 1 1 1 RG 20.58 w 226.3 528.85 m 567 528.85 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 26.14 762.8 m 569.2 762.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 739.97 m 569.2 739.97 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 717.14 m 569.2 717.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 694.31 m 569.2 694.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 540.26 m 569.2 540.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 785.63 m 569.2 785.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 762.8 m 569.2 762.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 739.97 m 569.2 739.97 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 717.14 m 569.2 717.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 694.31 m 569.2 694.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 540.26 m 569.2 540.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 517.43 m 569.2 517.43 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.22 786.71 m 27.22 516.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 225.17 786.71 m 225.17 516.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 568.12 786.71 m 568.12 516.35 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 769.45 Tm (Document Purpose)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 769.45 Tm (Inspection report)Tj ET /F2 12 Tf BT 1 0 0 1 31.2 746.62 Tm (Author)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 746.62 Tm (CSCI)Tj ET /F2 12 Tf BT 1 0 0 1 31.2 723.79 Tm (Audience)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 723.79 Tm (General public)Tj ET /F2 12 Tf BT 1 0 0 1 31.2 700.96 Tm (Further copies from)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 700.96 Tm (0870 240 7535 \(telephone order line\))Tj ET /F2 12 Tf BT 1 0 0 1 31.2 678.13 Tm (Copyright)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 678.13 Tm (Copyright \()Tj ET /F2 12 Tf BT 1 0 0 1 313.49 678.13 Tm (2009)Tj ET /F2 12 Tf BT 1 0 0 1 344.02 678.13 Tm (\) Commission for Social Care )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 663.55 Tm (Inspection \(CSCI\). This publication may be reproduced )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 648.97 Tm (in whole or in part, free of charge, in any format or )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 634.39 Tm (medium provided that it is not used for commercial )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 619.81 Tm (gain. This consent is subject to the material being )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 605.23 Tm (reproduced accurately and on proviso that it is not )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 590.65 Tm (used in a derogatory manner or misleading context. )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 576.07 Tm (The material should be acknowledged as CSCI )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 561.49 Tm (copyright, with the title and date of publication of the )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 546.91 Tm (document specified.)Tj ET /F2 12 Tf BT 1 0 0 1 31.2 524.08 Tm (Internet address)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 524.08 Tm (www.cqc.org.uk)Tj ET endstream endobj 14 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 15 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 485.42 30.79 Tm (Page)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 515.95 30.79 Tm (4)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 523.58 30.79 Tm ( of )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 541.88 30.79 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F1 14 Tf BT 1 0 0 1 28.35 795.65 Tm (,QIRUPDWLRQDERXWWKHFDUHKRPH)Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 774.22 m 267.95 774.22 l S 0.001 w 1 1 1 RG 20.58 w 270.2 774.22 m 565.65 774.22 l S 0.001 w 0.99608 0.9451 0.76078 RG 73.32 w 31.2 725.02 m 267.95 725.02 l S 0.001 w 1 1 1 RG 73.32 w 270.2 725.02 m 565.65 725.02 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 675.82 m 267.95 675.82 l S 0.001 w 1 1 1 RG 20.58 w 270.2 675.82 m 565.65 675.82 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 652.99 m 267.95 652.99 l S 0.001 w 1 1 1 RG 20.58 w 270.2 652.99 m 565.65 652.99 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 630.16 m 267.95 630.16 l S 0.001 w 1 1 1 RG 20.58 w 270.2 630.16 m 565.65 630.16 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 607.33 m 267.95 607.33 l S 0.001 w 1 1 1 RG 20.58 w 270.2 607.33 m 565.65 607.33 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 762.8 m 567.85 762.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 687.23 m 567.85 687.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 664.4 m 567.85 664.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 641.57 m 567.85 641.57 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 618.74 m 567.85 618.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 785.63 m 567.85 785.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 762.8 m 567.85 762.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 687.23 m 567.85 687.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 664.4 m 567.85 664.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 641.57 m 567.85 641.57 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 618.74 m 567.85 618.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 595.91 m 567.85 595.91 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 786.71 m 30.07 594.84 l S 0.001 w [] 0 d [] 0 d 2.25 w 269.07 786.71 m 269.07 594.84 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.77 786.71 m 566.77 594.84 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 769.45 Tm (Name of care home:)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 769.45 Tm (Abbey Grange)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 746.62 Tm (Address:)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 746.62 Tm (47 Venns Lane)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 729.04 Tm (Hereford)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 711.46 Tm (Herefordshire)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 693.88 Tm (HR1 1DT)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 671.05 Tm (Telephone number:)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 671.05 Tm (01432271519)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 648.22 Tm (Fax number:)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 648.22 Tm (01432271519)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 625.39 Tm (Email address:)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 625.39 Tm (ubheedave@yahoo.co.uk)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 602.56 Tm (Provider web address:)Tj ET 0.99608 0.9451 0.76078 RG 35.16 w 31.2 556.83 m 353.25 556.83 l S 0.001 w 1 1 1 RG 35.16 w 355.5 556.83 m 565.9 556.83 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 526.71 m 353.25 526.71 l S 0.001 w 1 1 1 RG 20.58 w 355.5 526.71 m 565.9 526.71 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 503.88 m 353.25 503.88 l S 0.001 w 1 1 1 RG 20.58 w 355.5 503.88 m 565.9 503.88 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 538.13 m 568.1 538.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 515.3 m 568.1 515.3 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 575.54 m 568.1 575.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 538.13 m 568.1 538.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 515.3 m 568.1 515.3 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 492.47 m 568.1 492.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 576.61 m 30.07 491.39 l S 0.001 w [] 0 d [] 0 d 2.25 w 354.37 576.61 m 354.37 491.39 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 576.61 m 567.02 491.39 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 559.35 Tm (Name of registered provider\(s\):)Tj ET /F2 12 Tf BT 1 0 0 1 358.35 559.35 Tm (Mrs Aileen Ubhee,Mr Bissessur )Tj ET /F2 12 Tf BT 1 0 0 1 358.35 544.77 Tm (Ubhee)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 521.94 Tm (Type of registration:)Tj ET /F2 12 Tf BT 1 0 0 1 358.35 521.94 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 499.11 Tm (Number of places registered:)Tj ET /F2 12 Tf BT 1 0 0 1 358.35 499.11 Tm (29)Tj ET /F2 10 Tf BT 1 0 0 1 28.35 480.17 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 460.68 m 565.6 460.68 l S 0.001 w 41.16 w 31.2 427.56 m 297.2 427.56 l S 0.001 w 20.58 w 299.45 437.85 m 565.6 437.85 l S 0.001 w 20.58 w 299.45 417.27 m 432.52 417.27 l S 0.001 w 20.58 w 432.52 417.27 m 565.6 417.27 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 449.26 m 567.8 449.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 472.09 m 567.8 472.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 449.26 m 567.8 449.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 405.85 m 567.8 405.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 473.17 m 30.07 404.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 298.32 450.34 m 298.32 404.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.72 473.17 m 566.72 404.77 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 455.91 Tm (Conditions of registration:)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 433.08 Tm (Category\(ies\) :)Tj ET /F2 12 Tf BT 1 0 0 1 302.3 433.08 Tm (Number of places \(if applicable\):)Tj ET /F2 12 Tf BT 1 0 0 1 302.3 412.5 Tm (Under 65)Tj ET /F2 12 Tf BT 1 0 0 1 435.37 412.5 Tm (Over 65)Tj ET 1 1 1 RG 20.58 w 31.2 391.06 m 297.3 391.06 l S 0.001 w 20.58 w 299.55 391.06 m 431.45 391.06 l S 0.001 w 20.58 w 433.7 391.06 m 565.6 391.06 l S 0.001 w 35.16 w 31.2 360.94 m 297.3 360.94 l S 0.001 w 35.16 w 299.55 360.94 m 431.45 360.94 l S 0.001 w 35.16 w 433.7 360.94 m 565.6 360.94 l S 0.001 w 35.16 w 31.2 323.53 m 297.3 323.53 l S 0.001 w 35.16 w 299.55 323.53 m 431.45 323.53 l S 0.001 w 35.16 w 433.7 323.53 m 565.6 323.53 l S 0.001 w 20.58 w 31.2 293.41 m 297.3 293.41 l S 0.001 w 20.58 w 299.55 293.41 m 431.45 293.41 l S 0.001 w 20.58 w 433.7 293.41 m 565.6 293.41 l S 0.001 w 0.99608 0.9451 0.76078 RG 20.58 w 31.2 270.58 m 565.6 270.58 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 379.65 m 567.8 379.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 342.24 m 567.8 342.24 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 304.83 m 567.8 304.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 282 m 567.8 282 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 259.17 m 567.8 259.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 236.34 m 568.1 236.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 402.48 m 567.8 402.48 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 379.65 m 567.8 379.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 342.24 m 567.8 342.24 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 304.83 m 567.8 304.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 282 m 567.8 282 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 259.17 m 568.1 259.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 236.34 m 568.1 236.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 198.93 m 568.1 198.93 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 403.55 m 30.07 197.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 298.42 403.55 m 298.42 280.92 l S 0.001 w [] 0 d [] 0 d 2.25 w 432.57 403.55 m 432.57 280.92 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.72 403.55 m 566.72 197.85 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 386.29 Tm (dementia)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 386.29 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 386.29 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 363.46 Tm (mental disorder, excluding learning )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 348.88 Tm (disability or dementia)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 363.46 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 363.46 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 326.05 Tm (old age, not falling within any other )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 311.47 Tm (category)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 326.05 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 326.05 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 288.64 Tm (physical disability)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 288.64 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 288.64 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 265.81 Tm (Additional conditions: )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 242.98 Tm (All residents must be at least 50 years of age on admission. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 220.15 Tm (That Mr Ubhee works a minimum of 30 hours a week at Abbey Grange in order to fulfil )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 205.57 Tm (his responsibilities as the Care Manager. )Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 184.14 m 315.25 184.14 l S 0.001 w 1 1 1 RG 20.58 w 317.5 184.14 m 346.55 184.14 l S 0.001 w 20.58 w 348.8 184.14 m 377.9 184.14 l S 0.001 w 20.58 w 380.15 184.14 m 409.2 184.14 l S 0.001 w 20.58 w 411.45 184.14 m 440.55 184.14 l S 0.001 w 20.58 w 442.8 184.14 m 471.9 184.14 l S 0.001 w 20.58 w 474.15 184.14 m 503.2 184.14 l S 0.001 w 20.58 w 505.45 184.14 m 534.55 184.14 l S 0.001 w 20.58 w 536.8 184.14 m 565.9 184.14 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 195.55 m 568.1 195.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 172.72 m 568.1 172.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 196.63 m 30.07 171.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 316.37 196.63 m 316.37 171.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 347.67 196.63 m 347.67 171.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 379.02 196.63 m 379.02 171.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 410.32 196.63 m 410.32 171.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 441.67 196.63 m 441.67 171.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 473.02 196.63 m 473.02 171.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 504.32 196.63 m 504.32 171.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 535.67 196.63 m 535.67 171.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 196.63 m 567.02 171.65 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 179.37 Tm (Date of last inspection)Tj ET /F2 12 Tf BT 1 0 0 1 328.2 179.37 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 359.53 179.37 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 390.86 179.37 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 422.18 179.37 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 453.53 179.37 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 484.86 179.37 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 516.18 179.37 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 547.53 179.37 Tm (8)Tj ET 0.99608 0.9451 0.76078 RG 17 w 31.2 160.85 m 565.9 160.85 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 151.22 m 568.1 151.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 152.3 m 30.07 39.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 152.3 m 567.02 39.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 170.47 m 568.1 170.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 151.22 m 568.1 151.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 40.22 m 568.1 40.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 171.55 m 30.07 150.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 171.55 m 567.02 150.15 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 157.29 Tm (Brief description of the )Tj ET /F2 12 Tf BT 1 0 0 1 177.31 157.29 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 138.04 Tm (Abbey Grange is situated in a residential area on the outskirts of Hereford city. There )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 121.04 Tm (is a parking area at the front of the home and local buses pass within easy reach. The )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 104.04 Tm (original part of the premises has been adapted for its current use. It carries a listed )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 87.04 Tm (building status. This places some restriction for making desired alterations. The original )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 70.04 Tm (building has been extended to provide additional, purpose-built accommodation. The )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 53.04 Tm (home is registered to provide care to 29 people who are over 50 years of age and who )Tj ET endstream endobj 16 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 17 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 485.42 30.79 Tm (Page)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 515.95 30.79 Tm (5)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 523.58 30.79 Tm ( of )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 541.88 30.79 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 17 w 31.2 804.03 m 565.9 804.03 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 794.4 m 568.1 794.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 795.48 m 30.07 706.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 795.48 m 567.02 706.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.1 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 794.4 m 568.1 794.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 707.15 m 568.1 707.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 793.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 814.73 m 567.02 793.33 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 800.47 Tm (Brief description of the )Tj ET /F2 12 Tf BT 1 0 0 1 177.31 800.47 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 33.25 783.47 Tm (have needs arising from old age, dementia or mental disorder. Information about the )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 766.47 Tm (service is displayed in the main entrance hall of the home. A copy of the most recent )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 749.47 Tm (inspection report is also displayed. A schedule of fees is available from the home. )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 732.47 Tm (Additional charges are made for hairdressing, transport, escort, chiropody, toiletries )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 715.47 Tm (and newspapers.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 695.09 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 678.09 Tm ()Tj ET endstream endobj 18 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 20 0 obj <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 529/Matrix [1 0 0 1 0 0]>>stream xMo0>eGJ%NrCnRVgJX*";?~&l#jWFC +e2!c2 X|>sARARe 5X )7gptj^"_=A+ҍefAkvkjO/l|% I()T09]r9Dܑs1T% *p@.](hm-*` \U%!`J9!둡h.3>'lt;(Uj* !Cb\lDV>>j0M^5 QUBk]ߒΩ9ݪ\v8yO_ّ.讹09zFvp3n,*JV9{GV!Tg k+xx8`D6 )Ь_oN,.8ql)l>Kkg7-u]3shWny~vx endstream endobj 21 0 obj<> endobj 22 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 17.5 w 28.35 55.27 m 568.35 55.27 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 33.75 51.96 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 483.75 52.97 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 514.27 52.97 Tm (6)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 521.27 52.97 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 539.56 52.97 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 801.59 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 28.35 786.6 Tm ()Tj ET /F1 14 Tf BT 1 0 0 1 28.35 761.65 Tm (6XPPDU\\)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 740.7 Tm (This is an overview of what we found during the inspection.)Tj ET 0.99608 0.9451 0.76078 RG 20.58 w 31.2 720.22 m 381.05 720.22 l S 0.001 w 1 1 1 RG 20.58 w 383.3 720.22 m 566.2 720.22 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 731.64 m 568.4 731.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 708.81 m 568.4 708.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 732.71 m 30.07 707.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 382.17 732.71 m 382.17 707.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 732.71 m 567.32 707.73 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 715.45 Tm (The quality rating for this )Tj ET /F2 12 Tf BT 1 0 0 1 191.92 715.45 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 255.59 715.45 Tm ( is:)Tj ET /F2 12 Tf BT 1 0 0 1 410.5 715.45 Tm (zero star poor service)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 683.31 Tm (2XUMXGJHPHQWIRUHDFKRXWFRPH)Tj ET /F2 10 Tf BT 1 0 0 1 212.29 607.27 Tm (Choice of home)Tj ET /F2 10 Tf BT 1 0 0 1 164.41 567.02 Tm (Health and personal care)Tj ET /F2 10 Tf BT 1 0 0 1 145.18 526.77 Tm (Daily life and social activities)Tj ET /F2 10 Tf BT 1 0 0 1 157.95 486.52 Tm (Complaints and protection)Tj ET /F2 10 Tf BT 1 0 0 1 226.36 446.27 Tm (Environment)Tj ET /F2 10 Tf BT 1 0 0 1 251.17 406.02 Tm (Staffing)Tj ET /F2 10 Tf BT 1 0 0 1 127.47 365.77 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75161 305.05 300.32 cm /Xf1 Do Q 1 1 1 RG 20.58 w 31.2 249.07 m 567.85 249.07 l S 0.001 w 171.39 w 32.32 150.84 m 566.72 150.84 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 31.2 237.66 m 567.85 237.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 237.66 m 568.92 237.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 64.02 m 568.92 64.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 238.74 m 31.2 62.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 238.74 m 567.85 62.94 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 244.3 Tm (How we did our inspection:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 35.17 221.48 Tm (We spent a day at the home observing daily life, talking to the people who use the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 206.9 Tm (service and the staff. We looked at the records which must be kept by the home to )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 192.32 Tm (show that it is being run properly. These include records relating to the care of people )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 177.74 Tm (who use the service and records about staff recruitment and training.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 163.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 148.57 Tm (The service had previously completed an Annual Quality Assurance Assessment )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 133.99 Tm (\(AQAA\). The AQAA is a self-assessment that focuses on how well outcomes are being )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 119.42 Tm (met for people using the service. It also gives us some numerical information about the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 104.83 Tm (service.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 90.25 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 75.68 Tm (We also received completed survey forms from people who use the service, their )Tj ET endstream endobj 23 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/XObject<>>>/MediaBox[0 0 595 842]>> endobj 24 0 obj <>stream 0 J 1 1 1 RG 236.28 w 32.32 694.39 m 566.72 694.39 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 813.65 m 568.92 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 575.12 m 568.92 575.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 814.73 m 31.2 574.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 814.73 m 567.85 574.05 l S 0.001 w [] 0 d /F2 12 Tf 0 0 0 rg BT 1 0 0 1 32.92 802.72 Tm (relatives and health and social care professionals who work with the home. The )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 788.14 Tm (information from these sources helps us understand how well the home is meeting the )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 773.56 Tm (needs of the people using the service.)Tj ET /F2 12 Tf BT 1 0 0 1 32.92 758.98 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 744.4 Tm (We also took into account information from random inspections that we did in February )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 729.82 Tm (and March 2009 and from discussions with local health and social care professionals )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 715.24 Tm (under multi-agency safeguarding adults arrangements. We have referred in this report )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 700.66 Tm (to a complaint we received shortly after our site visit. This was about medication )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 686.08 Tm (arrangements and fire safety. We referred these matters to Mr Ubhee and to Hereford )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 671.5 Tm (and Worcester Fire and Rescue Service. We have included information about their )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 656.92 Tm (responses in the relevant sections of this report.)Tj ET /F2 12 Tf BT 1 0 0 1 32.92 642.34 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 627.76 Tm (At this inspection we were following up requirements from inspections in October 2008, )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 613.18 Tm (February 2009 and March 2009. We were also checking compliance with statutory )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 598.6 Tm (requirement notices served after the February and March inspections. We served these )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 584.02 Tm (because requirements relating to recruitment and medication had not been met.)Tj ET endstream endobj 25 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 26 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 52.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (8)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 515.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 20.58 w 31.2 803.36 m 567.85 803.36 l S 0.001 w 195.54 w 32.32 693.05 m 566.72 693.05 l S 0.001 w 20.58 w 32.7 582.74 m 569.35 582.74 l S 0.001 w 166.38 w 33.82 487.01 m 568.22 487.01 l S 0.001 w 20.58 w 33.45 391.28 m 570.1 391.28 l S 0.001 w 287.77 w 34.57 234.86 m 568.97 234.86 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 31.2 791.95 m 567.85 791.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 791.95 m 568.92 791.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 594.16 m 568.92 594.16 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 793.03 m 31.2 593.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 594.16 m 569.35 594.16 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.7 571.33 m 569.35 571.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.62 571.33 m 570.42 571.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.62 402.7 m 570.42 402.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 379.87 m 570.1 379.87 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 402.7 m 570.1 402.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.37 379.87 m 571.17 379.87 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.37 89.85 m 571.17 89.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.7 572.41 m 32.7 401.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 380.95 m 33.45 88.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 793.03 m 567.85 593.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 569.35 572.41 m 569.35 401.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 570.1 380.95 m 570.1 88.77 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 798.59 Tm (What the )Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 90.52 798.59 Tm (care home)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 154.2 798.59 Tm ( does well:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 567.85 801.25 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 775.76 Tm (The home is in a good location in Hereford with easy access for visitors, particularly if )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 761.18 Tm (they need to use public transport.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 746.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 732.02 Tm (Abbey Grange is an informal and friendly place to visit. People we heard from )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 717.44 Tm (emphasised how friendly and willing the staff are and that nothing is too much trouble )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 702.86 Tm (for them. For example, one person who lives there wrote - "yes, they always look after )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 688.28 Tm (me very well" and a relative wrote - "Mum and I think Abbey Grange is a wonderful )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 673.7 Tm (home. We have nothing but praise in all they do - very caring staff".)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 659.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 644.54 Tm (We know that staff work hard and want to improve the service that the home provides.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 629.96 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 615.38 Tm (The house is generally clean and warm and has a homely atmosphere.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 600.8 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 568.97 691.5 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 580.63 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 32.7 577.97 Tm (What has improved since the last inspection?)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 569.35 581.19 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 485.46 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 555.14 Tm (Staff have worked very hard \(some in their own time\) to improve the written )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 540.56 Tm (information about the care each person needs. Further developments are needed but )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 525.98 Tm (information is more comprehensive and more accurate than was previously the case.)Tj ET /F2 12 Tf BT 1 0 0 1 36.67 511.4 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 496.82 Tm (Considerable improvements have been made in the way that medication is dealt with )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 482.24 Tm (but we found that a person had not had an item of their prescribed medication )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 467.66 Tm (administered for three weeks.)Tj ET /F2 12 Tf BT 1 0 0 1 36.67 453.08 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 438.5 Tm (More training is being organised so that staff can improve their knowledge and skills.)Tj ET /F2 12 Tf BT 1 0 0 1 36.67 423.92 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 409.34 Tm (Steps are being taken to make people's personal money available to them at all times.)Tj ET /F2 10 Tf BT 1 0 0 1 570.47 485.46 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 389.73 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 33.45 386.51 Tm (What they could do better:)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 31.2 233.31 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 363.68 Tm (The home needs to provide up to date and accurate information for people about the )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 349.1 Tm (service that the home is able to provide. The owners should be giving careful )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 334.52 Tm (consideration to the home's ability to offer accommodation to people with dementia )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 319.94 Tm (related care needs. They need to take significant steps to develop this aspect of the )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 305.36 Tm (service.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 290.78 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 276.2 Tm (The home needs to consider ways \(including staffing levels\) to improve the attention )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 261.62 Tm (and support they give to people living at the home including at meal times. Staffing )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 247.04 Tm (levels at the home should be based on the needs of individual people living there, the )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 232.46 Tm (overall combined needs of the population of the home and the layout and design of the )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 217.88 Tm (premises. The owners should be able to demonstrate how they have arrived at the )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 203.3 Tm (staffing levels provided.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 188.72 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 174.14 Tm (Further improvements are needed to the way medication is managed to make sure )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 159.56 Tm (that people always receive the medication prescribed for them. This is the third )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 144.98 Tm (occasion we have raised this and we are now considering further enforcement action.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 130.4 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 115.82 Tm (Whilst in recent months more activities have been arranged these are based on a )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 101.24 Tm (limited list of things and not enough has been done to find out what individual people )Tj ET endstream endobj 27 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 28 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 52.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (9)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 515.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 513.3 w 34.57 555.88 m 568.97 555.88 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 32.37 813.65 m 571.17 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.37 298.1 m 571.17 298.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 814.73 m 33.45 297.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 570.1 814.73 m 570.1 297.03 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.17 802.72 Tm (might like to spend their time doing. Similarly, people living at the home need to be )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 788.14 Tm (given more opportunities to influence the range of meals provided.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 773.56 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 758.98 Tm (The communal rooms are currently too crowded and improvements are needed to the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 744.4 Tm (premises to provide more space and choice for people. Facilities for private discussions, )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 729.82 Tm (health appointments and phone calls about people living at the home need to be )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 715.24 Tm (improved to ensure that people's privacy and dignity are upheld and confidentiality )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 700.66 Tm (maintained. If the owners intend to continue accommodating people with dementia the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 686.08 Tm (environment of the home needs to be developed in line with nationally recognised good )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 671.5 Tm (practice in dementia care. Improvements are also needed to make sure the home is )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 656.92 Tm (safe in respect of fire safety. Specialist advice needs to be taken about the sluice and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 642.34 Tm (laundry facilities.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 627.76 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 613.18 Tm (Staff recruitment arrangements are inadequate and these must be improved to )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 598.6 Tm (minimise the risk of unsuitable staff being employed. This is the third occasion we have )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 584.02 Tm (raised this and are now considering further enforcement action. Some aspects of how )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 569.44 Tm (staff training is organised and recorded need to be improved. Induction training )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 554.86 Tm (provided to staff must be based on nationally recognised induction standards. More )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 540.28 Tm (staff need to be trained in essential health and safety related subjects such as first aid.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 525.7 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 511.12 Tm (The way that the home is managed needs to be improved. We are not satisfied that Mr )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 496.54 Tm (Ubhee only being at the home for three days a week is an effective way to manage the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 481.96 Tm (home and consider that the home lacks effective leadership. We consider that he )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 467.38 Tm (should review his working pattern so that he fulfills the requirement to be in 'full time )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 452.8 Tm (day to day charge of the care home'.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 438.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 423.64 Tm (We have acknowledged in this report that the surveys we received from people who )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 409.06 Tm (live at the home and from relatives gave a positive view of the home and that some )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 394.48 Tm (did not agree with the 0 star rating we gave the home in October 2008. We also )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 379.9 Tm (acknowledge that staff at the home want to do whatever they can to improve things. )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 365.32 Tm (Having said this, our inspections in February, March and May have confirmed to us that )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 350.74 Tm (there are shortcomings in the service provided at Abbey Grange which the owners )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 336.16 Tm (must attend to. Some of the concerns relate to issues not necessarily evident to )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 321.58 Tm (visitors but all have an impact on the health, safety and well being of people who live )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 307 Tm (at the home, some of whom are not in a position for their voices to be heard. )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 283.54 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 263.55 Tm (If you want to know what action the person responsible for this )Tj ET /F2 12 Tf BT 1 0 0 1 416.37 263.55 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 480.04 263.55 Tm ( is taking )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 246.05 Tm (following this report, you can contact them using the details set out on page 4.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 226.06 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 206.06 Tm (The report of this inspection is available from our website )Tj ET /F2 12 Tf BT 1 0 0 1 380.85 206.06 Tm (www.cqc.org.uk.)Tj ET /F2 12 Tf BT 1 0 0 1 490.78 206.06 Tm (You can get )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 188.56 Tm (printed copies from )Tj ET /F2 12 Tf BT 1 0 0 1 149.87 188.56 Tm (enquiries@cqc.org.uk or by telephoning our order line )Tj ET /F2 12 Tf BT 1 0 0 1 488.4 188.56 Tm (0870 240 )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 171.07 Tm (7535.)Tj ET endstream endobj 29 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 30 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 52.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (10)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 53.04 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 28.35 801.59 Tm ()Tj ET /F2 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 782.58 Tm (Details of our findings)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 26 w 32.32 746.27 m 562.53 746.27 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 761.52 m 565.85 761.52 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 733.27 m 565.85 733.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 762.6 m 30.07 732.19 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 762.6 m 564.78 732.19 l S 0.001 w [] 0 d /F1 12 Tf BT 1 0 0 1 34.05 744.39 Tm (&RQWHQWV)Tj ET 1 1 1 RG 16 w 28.35 700.02 m 566.93 700.02 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 695.96 Tm (Choice of home \(standards 1 - 6\))Tj ET 16 w 28.35 678.02 m 566.93 678.02 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 673.96 Tm (Health and personal care \(standards 7 - 11\))Tj ET 16 w 28.35 656.02 m 566.93 656.02 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 651.96 Tm (Daily life and social activities \(standards 12 - 15\))Tj ET 16 w 28.35 634.02 m 566.93 634.02 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 629.96 Tm (Complaints and protection \(standards 16 - 18\))Tj ET 16 w 28.35 612.02 m 566.93 612.02 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 607.96 Tm (Environment \(standards 19 - 26\))Tj ET 16 w 28.35 590.02 m 566.93 590.02 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 585.96 Tm (Staffing \(standards 27 - 30\))Tj ET 16 w 28.35 568.02 m 566.93 568.02 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 563.96 Tm (Management and administration \(standards 31 - 38\))Tj ET /F2 12 Tf BT 1 0 0 1 28.35 543.96 Tm (Outstanding statutory requirements)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 522.09 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 31 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 33 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (11)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 768.13 Tm (Choice of home)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 12 Tf BT 1 0 0 1 28.35 747.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.81 Tm (These are the outcomes that people )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 730.81 Tm (staying in care homes)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 730.81 Tm ( should experience. They )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 713.31 Tm (reflect the things that people have said are important to them:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 700.85 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 206.25 w 32.32 593.29 m 562.53 593.29 l S 0.001 w 1 1 1 RG 119 w 31.2 550.79 m 563.65 550.79 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 611.42 m 565.85 611.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 698.67 m 565.85 698.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 611.42 m 565.85 611.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 490.17 m 565.85 490.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 699.74 m 30.07 489.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 699.74 m 564.78 489.09 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 685.48 Tm (People are confident that the care home can support them. This is because there is an )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.48 Tm (accurate assessment of their needs that they, or people close to them, have been )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.48 Tm (involved in. This tells the home all about them and the support they need. People who )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.48 Tm (stay at the home only for intermediate care, have a clear assessment that includes a )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 617.48 Tm (plan on what they hope for and want to achieve when they return home.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 598.23 Tm (People can decide whether the care home can meet their support and accommodation )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 581.23 Tm (needs. This is because they, or people close to them, have been able to visit the home )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 564.23 Tm (and have got full, clear, accurate and up to date information about the home. If they )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 547.23 Tm (decide to stay in the home they know about their rights and responsibilities because )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 530.23 Tm (there is an easy to understand contract or statement of terms and conditions between )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 513.23 Tm (them and the care home that includes how much they will pay and what the home )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 496.23 Tm (provides for the money.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 471.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 449.86 Tm (This is what people )Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 148.49 449.86 Tm (staying in this care home)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 305.46 449.86 Tm (experience)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 370.91 449.86 Tm (:)Tj ET /F6 8 Tf BT 1 0 0 1 28.35 432.68 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 137.47 w 33.45 360 m 563.65 360 l S 0.001 w 1 1 1 RG 22.5 w 31.2 419.73 m 565.9 419.73 l S 0.001 w 114.98 w 32.32 348.75 m 564.78 348.75 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 407.36 m 566.98 407.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 408.44 m 31.2 289.06 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 408.44 m 565.9 289.06 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 407.36 m 565.9 407.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 290.14 m 566.98 290.14 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 416.42 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 391.68 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 258.02 391.68 Tm (poor)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 289.42 391.68 Tm (quality outcomes in this area. We have made )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 374.18 Tm (this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 354.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 334.19 Tm (People considering moving to the home cannot be confident that the service has the )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 316.69 Tm (skills and resources needed to provide them with the care they need, particularly if )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 299.2 Tm (they have a dementia type illness. )Tj ET 0.99608 0.9451 0.76078 RG 196.04 w 33.45 166.24 m 563.65 166.24 l S 0.001 w 1 1 1 RG 22.5 w 31.2 255.27 m 565.9 255.27 l S 0.001 w 174.67 w 32.32 154.43 m 564.78 154.43 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 242.89 m 566.98 242.89 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 243.97 m 31.2 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 243.97 m 565.9 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 242.89 m 565.9 242.89 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 65.97 m 566.98 65.97 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 251.95 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 227.21 Tm (There was no one at the home on the day of our inspection who had recently moved )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 209.71 Tm (in. We therefore did not have the chance to speak with anyone about how this had )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 192.22 Tm (been dealt with. In surveys people indicated that they had enough information when )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 174.72 Tm (they moved in and one person had visited the home first.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 157.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 139.73 Tm (In their AQAA the owners told us that they obtain full information from people and )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 122.23 Tm (those close to them so they can decide if Abbey Grange can provide them with the )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 104.74 Tm (service they need. They also told us that they 'allow' people to visit but that )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 87.24 Tm (sometimes relatives have to do this for them depending on circumstances. They also )Tj ET endstream endobj 35 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 36 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (12)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 653.73 w 33.45 484.54 m 563.65 484.54 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 632.36 w 32.32 472.73 m 564.78 472.73 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 154.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 154.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 155.43 m 566.98 155.43 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (told us that 'in certain circumstances' someone goes to visit prospective residents as )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (part of the assessment process. We would expect the process of deciding if the home )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (is right for someone to always include a visit to the person either in their own home or )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (in hospital and for a visit to Abbey Grange to be actively encouraged rather than just )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (allowed. The admission policy we were given to read following the inspection does )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (indicate a more positive approach to visits. The owners have since told us that they )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (actively encourage people to visit.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (In the AQAA the owners told us that they record information about a range of areas for )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm ('each and every' person thinking of coming to the home. This has not been our )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (experience of the reality at the home and it is positive that the owners go on to say )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (they need "to write service user plans in more details \(sic\)". They have also told us )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (they plan to 'elaborate on our admission procedure to ensure that any care plan and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (any other assessment are well implemented'.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (We are concerned about the service's ability to look after the needs of people who )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (have dementia properly. This is because at present few staff have completed training )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (in this topic \(although most staff have started a distance learning course\) and because )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (the facilities at the home have not been adapted to the specific needs of people with )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (dementia in line with recognised good practice. We have observed examples of staff )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (finding the needs of people difficult to deal with and are aware that Herefordshire )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (Council, having re-assessed some people at the home have arranged for them to move )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (because their needs were not being met. Concerns about the service's ability to meet )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (the needs of people with dementia have been raised by health and social care )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (professionals at local multi-agency safeguarding meetings and in response to surveys )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (we sent to them.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (During the inspection we asked Mr Ubhee for copies of the service user guide and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (statement of purpose. He told us he is upgrading these and that they were not )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (currently available. In view of the concerns regarding the home's ability to look after )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (people with dementia we advised that the updated documents must clearly identify the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (level of needs that the home is able to cater for.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (Since our last inspection a clear emergency admission procedure has been written. No )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm (relevant admissions had taken place so we could not check how this procedure had )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (been used in practice.)Tj ET endstream endobj 37 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 38 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (13)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 768.13 Tm (Health and personal care)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 12 Tf BT 1 0 0 1 28.35 747.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.81 Tm (These are the outcomes that people )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 730.81 Tm (staying in care homes)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 730.81 Tm ( should experience. They )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 713.31 Tm (reflect the things that people have said are important to them:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 700.85 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 172.25 w 32.32 610.29 m 562.53 610.29 l S 0.001 w 1 1 1 RG 68 w 31.2 559.29 m 563.65 559.29 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 594.42 m 565.85 594.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 698.67 m 565.85 698.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 594.42 m 565.85 594.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 524.17 m 565.85 524.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 699.74 m 30.07 523.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 699.74 m 564.78 523.09 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 685.48 Tm (Peoples health, personal and social care needs are met. The home has a plan of care )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.48 Tm (that the person, or someone close to them, has been involved in making. If they take )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.48 Tm (medicine, they manage it themselves if they can. If they cannot manage their )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.48 Tm (medicine, the care home supports them with it, in a safe way. Peoples right to privacy )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 617.48 Tm (is respected and the support they get from staff is given in a way that maintains their )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 600.48 Tm (dignity.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 581.23 Tm (If people are approaching the end of their life, the care home will respect their choices )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 564.23 Tm (and help them feel comfortable and secure. They, and people close to them, are )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 547.23 Tm (reassured that their death will be handled with sensitivity, dignity and respect, and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 530.23 Tm (take account of their spiritual and cultural wishes. )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 505.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 483.86 Tm (This is what people )Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 148.49 483.86 Tm (staying in this care home)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 305.46 483.86 Tm (experience)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 370.91 483.86 Tm (:)Tj ET /F6 8 Tf BT 1 0 0 1 28.35 466.68 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 154.97 w 33.45 385.25 m 563.65 385.25 l S 0.001 w 1 1 1 RG 22.5 w 31.2 453.73 m 565.9 453.73 l S 0.001 w 132.47 w 32.32 374 m 564.78 374 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 441.36 m 566.98 441.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 442.44 m 31.2 305.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 442.44 m 565.9 305.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 441.36 m 565.9 441.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 306.64 m 566.98 306.64 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 450.42 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 425.68 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 258.02 425.68 Tm (poor)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 289.42 425.68 Tm (quality outcomes in this area. We have made )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 408.18 Tm (this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 388.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 368.19 Tm (People living at the home cannot be confident that they can rely on their health and )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 350.69 Tm (personal care needs being met and may not always be afforded the privacy they have )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 333.2 Tm (a right to expect. Arrangements for medication, though improved do not ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 315.7 Tm (people always receive the medication prescribed for them.)Tj ET 0.99608 0.9451 0.76078 RG 212.54 w 33.45 174.5 m 563.65 174.5 l S 0.001 w 1 1 1 RG 22.5 w 31.2 271.77 m 565.9 271.77 l S 0.001 w 191.17 w 32.32 162.69 m 564.78 162.69 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 259.4 m 566.98 259.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 260.47 m 31.2 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 260.47 m 565.9 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 259.4 m 565.9 259.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 65.97 m 566.98 65.97 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 268.46 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 243.71 Tm (In planning this key inspection we had conflicting information about the standard of )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 226.22 Tm (care provided at the home. In the surveys we received from people living there and )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 208.72 Tm (from relatives we were given some very positive comments about people's )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 191.22 Tm (experiences, for example -)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 173.73 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 156.23 Tm ("I am very happy at Abbey Grange")Tj ET /F2 12 Tf BT 1 0 0 1 35.47 138.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 121.24 Tm ("I like living here, it's my home")Tj ET /F2 12 Tf BT 1 0 0 1 35.47 103.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 86.25 Tm ("The doctor has been called out when necessary and I have had my eyes tested")Tj ET endstream endobj 39 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 40 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (14)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 742.05 w 33.45 440.38 m 563.65 440.38 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 720.68 w 32.32 428.57 m 564.78 428.57 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.1 m 566.98 67.1 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm ("This is a very caring home - the staff are very kind and genuinely caring and patient")Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (In their AQAA the owners told us that they maintain people's independence wherever )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (possible and facilitate good health by involving other agencies. During our inspection )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (we spoke to a number of people who live in the home and they expressed satisfaction )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (with their care. A large proportion of people at the home have dementia and are not all )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (able to express their views.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (Our experience, and that of other professionals in recent months has given a different )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (picture whereby some people have not had their needs met and there have been )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (concerns about people's welfare dealt with under local safeguarding arrangements.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (At previous inspections in the last year we found examples of poor care records that )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (provided staff with no guidance about the correct way to care for people at the home. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (This included situations where guidance was missing or contradictory about essential )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (aspects of some people's care. Social care staff had also identified this as a concern. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (For example, at one of their reviews they found a record that said the spouse of a )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (person also lived at the home although they had died two years before. This changed )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (the nature of the surviving spouce's care but the records had not been updated )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (accordingly.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (Because we had previously made a requirement about care records in October 2008 )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (we issued a statutory requirement notice. During this inspection we found that )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (sufficient progress had been made in improving the care plans that the notice had )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (been complied with. However, we expect more to be done in future to directly involve )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (the people concerned in the content of their care records as we found little evidence )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (that the recent work done had taken their contributions into account. We also saw )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (some records which still did not contain enough guidance to staff, for example about )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (how to deal with occasional aggressive behaviour by one person, about the nutritional )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (supplements for a person whose weight was a concern and for another with a health )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (need which would need staff to provide first aid from time to time.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (We are concerned that some of the work to improve the care records was done by )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm (staff in their own time, on occasions late into the evening after working all day. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (However some staff we spoke to said they had done this willingly to help improve )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm (things at the home. This commitment is commendable but is an indicator that Mr )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm (Ubhee is overly reliant on the good will and hard work of the staff team. We say more )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (about this in the management section of this report.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (During our random inspections in February and March 2009 we observed incidents )Tj ET endstream endobj 41 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 42 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (15)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 742.05 w 33.45 440.38 m 563.65 440.38 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 720.68 w 32.32 428.57 m 564.78 428.57 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.1 m 566.98 67.1 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (where staff were trying hard but struggling to cope with the needs of some people at )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (the home; particularly those with dementia. For example, we saw distressed residents )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (becoming increasingly agitated and disturbing other people at the home and staff )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (finding it hard to reassure them and give them the time needed to sooth them. Health )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (and social care professionals visiting the home have had similar experiences. During )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (the key inspection we again saw examples of lack of staff time having an effect on the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (quality of people's lives. For example during a mealtime we saw the following scenario )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (-)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (A person was taken to the table twice but each time they left and went and sat in the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (lounge, where they would again get up and start moving around. We noticed they )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (smelled strongly of urine. The person's lunch was taken to them in the lounge and put )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (on to a small table in front of them. The table was placed too far away for the person )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (to be able to feed themselves which is what they seemed to want to do. A member of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (staff sat with the person for less than 5 minutes during which time she cut the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (person's food into smaller pieces and helped them put some into their mouth. The )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (person was not very receptive so the staff member left them unattended. A little later )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (we found the person standing and pushing the table which was in the process of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (collapsing. Their drink fell on the floor and we alerted staff to the need for them to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (give assistance.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (Sometime later we found that this person had been given a change of clothes. A )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (member of staff told us that the person had been wet so needed changing. We asked )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (how staff knew whether people had been taken to toilet or had incontinence materials )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (changed but she did not know and gave no indication of a system in place for staff to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (make sure each person was attended to. When we told the manager about this )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (situation he said that the resident concerned was reluctant to go to the toilet and staff )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (might have had problems with her.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (We also saw a person passing another's discarded pudding to a third person after )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (eating some of it themselves. No staff were at hand to support these people in )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (managing their meals in a dignified way.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (In our surveys four people who live at the home said they always get the care they )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm (need whilst three said this is usually so. The same proportion of people said that staff )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (are always or usually available when needed. The situations we observed affected )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm (people unable to express their views about these issues due to dementia.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (We are concerned that people's right to have their privacy and dignity upheld is not )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm (always adhered to. There is a lack of private space for people to meet with social care )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (professionals or be seen by health professionals. We have observed meetings \(such as )Tj ET endstream endobj 43 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 44 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (16)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 742.05 w 33.45 440.38 m 563.65 440.38 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 720.68 w 32.32 428.57 m 564.78 428.57 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.1 m 566.98 67.1 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (care reviews\) and examinations by health service staff that should be carried out in )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (private taking place in the sitting and dining rooms. Some health and social care )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (professionals have told us of their concerns about this. One health professional told us )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (they have tried to overcome the problem by telling the home in advance what time )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (they will arrive so that staff can help a person to their room; they had done this on the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (day of our inspection but when they arrived the person was still in the sitting room and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (was examined there.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (We saw an overall improvement in the security and storage of medication. The area )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (used to store medication had been tidied with increased space provided for the desk )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (and medicine trolley. The medicine trolley was securely chained to a solid wall. We saw )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (that the manager held the medicine keys. This means that medication was safe and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (secure which protects the people who use the service from harm.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (We saw improved documentation in the care plans and also in the medication )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (administration folder stating the reason why medication was prescribed and in )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (particular there was better documentation for any medication prescribed on a when )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (required basis. We saw typed information about the medication people were prescribed )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (including what it was prescribed for, an action plan and what side effects the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (medication may cause. For example, one person had been prescribed medication for )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (agitation. We saw staff guidelines on when to administer the medication with a four )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (point action plan. This helped to ensure that staff were better informed about what )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (medication was prescribed for and also to ensure that the health and wellbeing of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (people who use the service were protected.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (The medication records had improved with increased checking and counting of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (medication. We saw records documenting weekly counts of medication, which helped )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (to ensure that medication was being administered as prescribed. We saw records for )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (the receipt and administration of medication. When medication administration record )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (\(MAR\) charts were changed or a new medication started then two members of staff )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (checked the records for accuracy. This helped to ensure that accurate medication )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (records were available.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (One area of concern during our inspection in October 2008 was the security of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm (medication and we did a random inspection in March 2009 which focused on )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (medication arrangements. We found that the previous requirement about safe storage )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm (was not met and served a statutory requirement notice. During this inspection we )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm (acknowledged that the service had changed and improved medication management )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (systems to ensure the safe administration of medication. However we found that one )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm (person had not received their prescribed medication for a three week period. The )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (prescribed medication was to be administered once a week on a Wednesday morning. )Tj ET endstream endobj 45 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 46 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (17)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 426.28 w 33.45 598.27 m 563.65 598.27 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 404.91 w 32.32 586.45 m 564.78 586.45 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 381.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 381.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 382.88 m 566.98 382.88 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (The records documented that the medication had been received into the service. We )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (saw that the MAR chart had not been signed for administration for three weeks )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (\(including the day of the inspection which was on a Wednesday\). We checked the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (medicine trolley for the medication and it was not available. The manager could not )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (find the medication in the medicine trolley or in any of the medicine store cupboards )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (and could not offer an explanation for this even though he had been the person )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (administering the medication that morning. There were no weekly checks recorded for )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (the availability of this medicine. It therefore appeared that the checking system had )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (failed to ensure that prescribed medication was available to administer at the right )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (time to the right person. This finding did cause concern for the health and wellbeing of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (the person. We also noted that another person, prescribed the same weekly )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (medication had not been given it that morning either although in that case, stock was )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (available. Because of these failings we concluded that the statutory requirement notice )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (had not been met and are taking further action about this.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (We read information in some care records about the use of certain creams \(Aqueous )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (and E45\) where the records said they should be applied sparingly because they make )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (the skin thin. This information is incorrect in respect of these products.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (Shortly after the inspection we received a complaint that Mr Ubhee had initiated a new )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (arrangement for taking medication to people. The arrangement described \(putting pots )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (of tablets on trays\) is poor practice and not acceptable. Mr Ubhee has written to us to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (refute the allegation and confirmed that this is not happening.)Tj ET endstream endobj 47 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 48 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (18)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 768.13 Tm (Daily life and social activities)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 12 Tf BT 1 0 0 1 28.35 747.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.81 Tm (These are the outcomes that people )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 730.81 Tm (staying in care homes)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 730.81 Tm ( should experience. They )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 713.31 Tm (reflect the things that people have said are important to them:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 700.85 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 138.25 w 32.32 627.29 m 562.53 627.29 l S 0.001 w 1 1 1 RG 17 w 31.2 567.79 m 563.65 567.79 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 577.42 m 565.85 577.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 698.67 m 565.85 698.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 577.42 m 565.85 577.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 558.17 m 565.85 558.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 699.74 m 30.07 557.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 699.74 m 564.78 557.09 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 685.48 Tm (Each person is treated as an individual and the care home is responsive to his or her )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.48 Tm (race, culture, religion, age, disability, gender and sexual orientation. They are part of )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.48 Tm (their local community. The care home supports people to follow personal interests and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.48 Tm (activities. People are able to keep in touch with family, friends and representatives. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 617.48 Tm (They are as independent as they can be, lead their chosen lifestyle and have the )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 600.48 Tm (opportunity to make the most of their abilities. People have nutritious and attractive )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 583.48 Tm (meals and snacks, at a time and place to suit them.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 564.23 Tm (There are no additional outcomes.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 539.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 517.86 Tm (This is what people )Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 148.49 517.86 Tm (staying in this care home)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 305.46 517.86 Tm (experience)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 370.91 517.86 Tm (:)Tj ET /F6 8 Tf BT 1 0 0 1 28.35 500.68 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 154.97 w 33.45 419.25 m 563.65 419.25 l S 0.001 w 1 1 1 RG 22.5 w 31.2 487.73 m 565.9 487.73 l S 0.001 w 132.47 w 32.32 408 m 564.78 408 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 475.36 m 566.98 475.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 476.44 m 31.2 339.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 476.44 m 565.9 339.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 475.36 m 565.9 475.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 340.64 m 566.98 340.64 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 484.42 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 459.68 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 258.02 459.68 Tm (poor)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 289.42 459.68 Tm (quality outcomes in this area. We have made )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 442.18 Tm (this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 422.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 402.19 Tm (People who live at Abbey Grange may not have their needs met in respect of day to )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 384.69 Tm (day life, provision of a nutritious diet and autonomy and choice; this is because )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 367.2 Tm (insufficient attention is paid to the specific needs of people in the home \(including )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 349.7 Tm (those with dementia\) and how they can be supported as individuals.)Tj ET 0.99608 0.9451 0.76078 RG 246.54 w 33.45 191.5 m 563.65 191.5 l S 0.001 w 1 1 1 RG 22.5 w 31.2 305.77 m 565.9 305.77 l S 0.001 w 225.17 w 32.32 179.69 m 564.78 179.69 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 293.4 m 566.98 293.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 294.47 m 31.2 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 294.47 m 565.9 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 293.4 m 565.9 293.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 65.97 m 566.98 65.97 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 302.46 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 277.71 Tm (A positive aspect of the service provided at the home is the friendly welcome visitors )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 260.22 Tm (receive from the staff and this was commented on by many of the relatives who )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 242.72 Tm (returned surveys to us. This view is shared by staff from Herefordshire Council who )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 225.22 Tm (have been visiting and this has also been our experience.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 207.73 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 190.23 Tm (When we did our inspection in October 2008 we found indications that people at the )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 172.74 Tm (home were bored and that requests for more choice about activities had not been )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 155.24 Tm (acted on. We made a requirement about the provision of opportunities for activities. )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 137.74 Tm (When we did our random inspection in February we found that Mr Ubhee had initiated )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 120.25 Tm (a programme of activities and people had been asked which of these they wanted to )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 102.75 Tm (take part in. This was not the outcome we had been intending which was for people at )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 85.26 Tm (the home to be consulted about what sorts of activities they would like to be offered, )Tj ET endstream endobj 49 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 50 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (19)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 742.05 w 33.45 440.38 m 563.65 440.38 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 720.68 w 32.32 428.57 m 564.78 428.57 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.1 m 566.98 67.1 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (either as individuals or in groups rather than being presented with a limited range )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (choice of things decided on by staff. Whilst we acknowledged that the requirement had )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (been met we wanted to see more done to focus on the preferences of each person and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (made a recommendation about this.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (In the AQAA the owner told us that people who live at Abbey Grange are enabled to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (take part in as many activities as they can and that we would find evidence of this in )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (the records at the home. The AQAA also included the information that people are )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (encouraged to plan their own activities. In the AQAA the owners informed us that they )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (were looking into which people would enjoy watching children's television )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (programmes. This concerns us as we are not aware of practice guidance to evidence )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (that this is of benefit to or enjoyed by older people. Mr Ubhee also said in the AQAA )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (that they "could encourage a 'toy of comfort' to service users". This is a strategy that )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (is beneficial for some people who have dementia but needs to be part of a planned )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (person centred approach to meeting their individual needs. We would have explored )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (both these issues with Mr Ubhee to ask what his reasoning was for these suggestions )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (and what reference he had made to good practice guidelines for dementia care. Due to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (his limited availability during the inspection we were unable to do so. Subsequently, Mr )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (Ubhee has informed us that he has consulted guidance regarding these approaches to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (care although he has not told us what sources he has used.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (In replies to our surveys one person said there are always activities for them to take )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (part in, two said this is usually the case and five that this is sometimes the case. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (During our inspection we looked at the activity records. These showed little evidence of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (individual activities or that reference had been made to best practice guidelines for )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (dementia care. The main activity recently had been bingo and we looked at the record )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (for one person which showed they had taken part in this four times in seven days but )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (had not done anything else. There was a bingo session arranged on the day of the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (inspection. A weekly plan in the activity folder showed that activities provided were )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (bingo, baking, puzzles, cards, writing and colouring but the records did not reflect that )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (this range of activities had happened.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm (The staff rota includes shows that time is allocated to a memeber of staff to do )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (activities five days a week. No evidence was available to show that staff have been )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm (trained for this role. We found no evidence to show that thought had been given to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (what individual people might prefer to spend their time doing. Our findings were )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm (supported by the findings of a monitoring visit by Herefordshire Council - "There is still )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm (no major input of choice from the residents that can be identified, there is major )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (dependence upon bingo and colouring but they appear to be happening daily". A social )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm (care professional had told us they observed staff changing the channel on the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (television \(from horse racing to a children's programme\) without first asking people )Tj ET endstream endobj 51 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 52 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (20)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 742.05 w 33.45 440.38 m 563.65 440.38 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 720.68 w 32.32 428.57 m 564.78 428.57 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.1 m 566.98 67.1 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (sitting in the room if this was what they wanted. We were told that a person trained to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (do music and movement now visits the home for exercise sessions.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (Some of the responses we received from relatives indicated that they had noticed an )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (increase in the level of activities being provided - 'definitely a huge improvement' - )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (although some said they think there is room for further improvement. One person )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (commented that there should be better provision for people to get outside for some )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (exercise. One person commented that they thought the home would be 'pretty awful' )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (for someone in need of more mental or physical stimulation. One social care )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (professional had been told by some people living at the home that they disliked it )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (when activities take place in the room they are sitting in because they don't )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (necessarily want to join in. The issues relating to the space available in the home are )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (covered in more detail in the environment section of this report.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (Some staff commented on wishing they had more time to provide activities but felt )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (this was limited due to their other duties. One staff survey highlighted the importance )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (of training for staff in providing activities and indicated a good understanding of the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (value of identifying suitable activities to suit individual people.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (People at the home and their relatives expressed general satisfaction with the quality )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (of the food provided although one relative told us that her relation is 'not keen on )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (some of the meals'. On the day of the inspection the person cooking had done a )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (midweek roast dinner. We noted that there was no meat left over if anyone had )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (wanted a second helping. The cook told us that left over vegetables are used to make )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (soup for tea. We observed the amount left on the day of our inspection was small and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (was used with stock cubes to make soup. People spoken with told us they enjoyed )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (their food and that they have sufficient. 50% of the surveys we received from people )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (who live at the home said they always like the meals, 50% said they sometimes like )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (them. During the day we saw that people were offered regular hot and cold drinks.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (As we were leaving the home we noted that tea was being served to people in their )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (armchairs in the sitting room. We only saw them being given sandwiches and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm (wondered how they would manage the soup we understood to be on the menu. We do )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (not know if this is the routine arrangement but hope that people who might prefer to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm (sit at the table would be supported to do so.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm (Neither of the cooks has had formal catering training although one of them said she is )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm (doing a course about nutrition. There was no evidence that people who live at the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (home are consulted for their views about the choice of meals provided. The cook on )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm (duty showed us records kept of the food each person has had. She has been delegated )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (responsibility for keeping these records up to date. We were concerned that this )Tj ET endstream endobj 53 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 54 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (21)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 93.86 w 33.45 764.48 m 563.65 764.48 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 72.48 w 32.32 752.67 m 564.78 752.67 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 714.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 714.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 715.3 m 566.98 715.3 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (includes retrospectively recording food from the previous day's tea, although she )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (would not have been there to see what people had. These records should be made by )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (staff who are present when the meal is taken and who have first hand knowledge of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (what people had eaten.)Tj ET endstream endobj 56 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 57 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (22)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 768.13 Tm (Complaints and protection)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 12 Tf BT 1 0 0 1 28.35 747.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.81 Tm (These are the outcomes that people )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 730.81 Tm (staying in care homes)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 730.81 Tm ( should experience. They )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 713.31 Tm (reflect the things that people have said are important to them:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 700.85 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 87.25 w 32.32 652.79 m 562.53 652.79 l S 0.001 w 1 1 1 RG 17 w 31.2 618.79 m 563.65 618.79 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 628.42 m 565.85 628.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 698.67 m 565.85 698.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 628.42 m 565.85 628.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 609.17 m 565.85 609.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 699.74 m 30.07 608.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 699.74 m 564.78 608.09 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 685.48 Tm (If people have concerns with their care, they or people close to them know how to )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.48 Tm (complain. Any concern is looked into and action taken to put things right. The care )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.48 Tm (home safeguards people from abuse and neglect and takes action to follow up any )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.48 Tm (allegations.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 615.23 Tm (Peoples legal rights are protected, including being able to vote in elections.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 590.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 568.86 Tm (This is what people )Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 148.49 568.86 Tm (staying in this care home)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 305.46 568.86 Tm (experience)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 370.91 568.86 Tm (:)Tj ET /F6 8 Tf BT 1 0 0 1 28.35 551.68 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 154.97 w 33.45 470.25 m 563.65 470.25 l S 0.001 w 1 1 1 RG 22.5 w 31.2 538.73 m 565.9 538.73 l S 0.001 w 132.47 w 32.32 459 m 564.78 459 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 526.36 m 566.98 526.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 527.44 m 31.2 390.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 527.44 m 565.9 390.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 526.36 m 565.9 526.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 391.64 m 566.98 391.64 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 535.42 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 510.68 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 258.02 510.68 Tm (adequate)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 318.25 510.68 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 493.18 Tm (made this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 473.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 453.19 Tm (Recent improvements mean that people living at Abbey Grange should have their )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 435.69 Tm (concerns taken seriously and be kept better informed about the action being taken. )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 418.2 Tm (Similar improvements have begun in providing safeguards in the event of a person )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 400.7 Tm (being abused or neglected. )Tj ET 0.99608 0.9451 0.76078 RG 297.54 w 33.45 217 m 563.65 217 l S 0.001 w 1 1 1 RG 22.5 w 31.2 356.77 m 565.9 356.77 l S 0.001 w 276.17 w 32.32 205.19 m 564.78 205.19 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 344.4 m 566.98 344.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 345.47 m 31.2 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 345.47 m 565.9 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 344.4 m 565.9 344.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 65.97 m 566.98 65.97 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 353.46 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 328.71 Tm (In their AQAA the owners acknowledged that they need to improve the way they deal )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 311.22 Tm (with complaints and that they are doing so. They told us they are now being more )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 293.72 Tm (open in listening to people and will take action accordingly. They told us that we would )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 276.22 Tm (find evidence of this in their monthly complaints record. When we looked at these )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 258.73 Tm (records during the inspection there was limited information because only one concern )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 241.23 Tm (had arisen. This matter had been referred to be investigated under local multi-agency )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 223.74 Tm (safeguarding arrangements. This showed a recognition by the owners that they have )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 206.24 Tm (to work in co-operation with outside agencies to protect people living at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 188.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 171.25 Tm (The surveys we received showed that most people said they knew who to speak to if )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 153.75 Tm (there was a concern they needed to raise although one person wrote - "It is a bit hit )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 136.26 Tm (and miss although communication has improved as I have got to know various )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 118.76 Tm (members of staff". One person who lives at the home wrote - "They \(the staff\) listen )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 101.26 Tm (but occasionally do not act on what I say". One relative told us that on one occasion )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 83.77 Tm (staff did not pass a message to her relation. The staff who sent surveys back said they )Tj ET endstream endobj 58 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 59 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (23)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 496.26 w 33.45 563.27 m 563.65 563.27 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 474.89 w 32.32 551.46 m 564.78 551.46 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 311.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 311.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 312.89 m 566.98 312.89 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (knew what to do if someone wishes to make a complaint. People we spoke to during )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (our visit were unsure about the complaints procedure but we saw that there was a )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (copy of this displayed on a notice board in the home.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (When we did our previous key inspection in October 2008 we were concerned that )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (very few staff had done training about the right action to take if they are concerned )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (that a person is being neglected or abused. Most staff have now done this training and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (those we spoke to on the day told us they would report any concerns to Mr Ubhee or )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (to the 'authorities'. The issue referred to above had come to light because a member )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (of staff had been concerned about a person not being given the care they needed and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (had reported this to Mr Ubhee. This is a reassuring indication that staff are now more )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (aware of their responsibilities. We noted that staff did their training in Swansea and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (would recommend that in future they do it in Hereford; this is because local training )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (would provide them with knowledge about the Herefordshire safeguarding procedures )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (which may differ from those in Swansea. During a meeting between Herefordshire )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (Council, ourselves and Mr Ubhee about this referral he showed concerns about steps )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (taken by the Council to get the views of the resident concerned. This indicated gaps in )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (his awareness of safeguarding procedures and the importance of putting the person )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (involved at the heart of any investigation. The staff training information we were given )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (by Mr Ubhee shows that he has not done recent safeguarding training himself; )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (something it is essential that he does. We recommend that he also does this training in )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (Herefordshire rather than in Swansea.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (The recruitment procedures at Abbey Grange are not sufficiently robust to make sure )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (that unsuitable staff are not employed. This means that people at the home may be )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (put at risk. This is explained in detail in the Staffing section of this report. We are )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (taking formal action about this.)Tj ET endstream endobj 60 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 61 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (24)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 768.13 Tm (Environment)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 12 Tf BT 1 0 0 1 28.35 747.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.81 Tm (These are the outcomes that people )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 730.81 Tm (staying in care homes)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 730.81 Tm ( should experience. They )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 713.31 Tm (reflect the things that people have said are important to them:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 700.85 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 104.25 w 32.32 644.29 m 562.53 644.29 l S 0.001 w 1 1 1 RG 68 w 31.2 627.29 m 563.65 627.29 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 662.42 m 565.85 662.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 698.67 m 565.85 698.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 662.42 m 565.85 662.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 592.17 m 565.85 592.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 699.74 m 30.07 591.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 699.74 m 564.78 591.09 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 685.48 Tm (People stay in a safe and well-maintained home that is homely, clean, pleasant and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.48 Tm (hygienic. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 649.23 Tm (People stay in a home that has enough space and facilities for them to lead the life )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 632.23 Tm (they choose and to meet their needs. The home makes sure they have the right )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 615.23 Tm (specialist equipment that encourages and promotes their independence. Their room )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 598.23 Tm (feels like their own, it is comfortable and they feel safe when they use it.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 573.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 551.86 Tm (This is what people )Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 148.49 551.86 Tm (staying in this care home)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 305.46 551.86 Tm (experience)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 370.91 551.86 Tm (:)Tj ET /F6 8 Tf BT 1 0 0 1 28.35 534.68 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 137.47 w 33.45 462 m 563.65 462 l S 0.001 w 1 1 1 RG 22.5 w 31.2 521.73 m 565.9 521.73 l S 0.001 w 114.98 w 32.32 450.75 m 564.78 450.75 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 509.36 m 566.98 509.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 510.44 m 31.2 391.06 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 510.44 m 565.9 391.06 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 509.36 m 565.9 509.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 392.14 m 566.98 392.14 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 518.42 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 493.68 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 258.02 493.68 Tm (poor)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 289.42 493.68 Tm (quality outcomes in this area. We have made )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 476.18 Tm (this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 456.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 436.19 Tm (People living at Abbey Grange do not benefit from an environment equipped to meet )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 418.69 Tm (their individual and specialist care needs and cannot be confident that all aspects of )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 401.2 Tm (their safety are adequately catered for.)Tj ET 0.99608 0.9451 0.76078 RG 298.04 w 33.45 217.24 m 563.65 217.24 l S 0.001 w 1 1 1 RG 22.5 w 31.2 357.27 m 565.9 357.27 l S 0.001 w 276.67 w 32.32 205.43 m 564.78 205.43 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 344.89 m 566.98 344.89 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 345.97 m 31.2 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 345.97 m 565.9 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 344.89 m 565.9 344.89 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 65.97 m 566.98 65.97 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 353.95 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 329.21 Tm (In the AQAA the owners told us that the home's maintenance problems are rectified )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 311.71 Tm (quickly and the grounds kept tidy for people who wish to go outside. They referred to )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 294.22 Tm (the limitations posed for them due to Abbey Grange being a listed building. The AQAA )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 276.72 Tm (refers to the new extension providing wheelchair access due to having wide doorways. )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 259.22 Tm (In reality the benefits of this are limited because these rooms can only be reached by )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 241.73 Tm (walking down a flight of stairs or using a stair lift. Access to all floors above or below )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 224.23 Tm (the ground floor is by stair lift; the building does not have a passenger lift. It is our )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 206.74 Tm (understanding from what the owners had said over the years that this is because )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 189.24 Tm (planning applications for a lift have been turned down.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 171.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 154.25 Tm (The house has a welcoming feel and people have been encouraged to personalise their )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 136.75 Tm (rooms with their own belongings. We saw one room where the person needs )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 119.26 Tm (equipment for moving and handing and found it was well arranged to meet these )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 101.76 Tm (needs and she was very happy with it. Just over half of the residents who sent surveys )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 84.26 Tm (back told us the home is always clean and fresh, the rest said this is usually the case.)Tj ET endstream endobj 62 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 63 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (25)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 742.05 w 33.45 440.38 m 563.65 440.38 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 720.68 w 32.32 428.57 m 564.78 428.57 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.1 m 566.98 67.1 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (No reference is made in the AQAA to how the owners make sure the needs of people )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (with dementia are met within the environment. We noted that apart from external )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (doors being alarmed to alert staff if someone goes outside there are no other design )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (features to help people with limited memory or understanding due to dementia. Good )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (practice would include using clear signs to help people locate bathrooms, toilets, their )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (own room etc; but signs for these were limited to room numbers or nothing at all. This )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (is an area which must be improved using nationally recognised good practice guidance )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (for dementia care homes if the owners continue to accomodate people with dementia.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (During our random inspection in February and March and during this inspection we )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (observed a level of overcrowding in the two main sitting rooms. This was also )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (commented on in a survey from a relative - "There should be a room to receive visitors )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (- it is rather crammed at present - perhaps too many residents and too many rooms )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (crammed on the site". We have already commented on the lack of space for private )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (meetings or health appointments earlier in this report; this is made more difficult due )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (to the lack of lift which means it takes some time for people to be helped back to their )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (own rooms. We noted that conversations and telephone calls conducted at the staff )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (workstation could be overheard in the nearby dining room. This means that people's )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (privacy and confidentiality are not being upheld.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (During this inspection we saw that most of the armchairs in the 'quiet' room and the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (TV room were occupied most of the time. One person told us she would like to go into )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (the other room to watch TV but, when she went to check she found there were no free )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (chairs. She therefore returned to the 'quiet' room. Chairs in both rooms are arranged )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (very close together and, in the TV room some face the back of a row of chairs in front. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (When a new extension was built to provide more bedrooms a small sitting room was )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (included in this. The room is only large enough for two or three people to use and on )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (the day we inspected was furnished with a small portable tv and hard office type )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (chairs, not armchairs. This means it would not be a comfortable place for someone to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (spend their time. The lack of communal space is a particular concern in a service which )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (is putting itself forward as able to cater for people with dementia because of the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm (impact on other people when someone becomes restless or agitated. During our )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (inspections in February and March we observed the effect this had and the upset it )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm (caused to other residents. During this inspection we saw a confrontation between two )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (people narrowly avoided due to a staff member intervening just in time.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm (Mr Ubhee has told us that he is trying to get planning and listed building consent for )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (an extra communal room leading off the quiet room. This would improve the situation )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm (as there would be more space for people and more choice about where to sit. Mr )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (Ubhee told us that his applications keep being turned down but that a person with )Tj ET endstream endobj 64 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 65 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (26)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 742.05 w 33.45 440.38 m 563.65 440.38 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 720.68 w 32.32 428.57 m 564.78 428.57 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.1 m 566.98 67.1 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (planning experience who is the appointee for a resident is now trying to help him put )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (forward acceptable plans.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (When we inspected in October and February we were concerned by a number of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (infection control issues and issued a statutory requirement notice about these. The )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (issue include lack of staff training in infection control and shortcomings in toilets and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (bathrooms such as open waste bins and lack of toilet roll holders, liquid soap or paper )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (towels. We also had concerns about precautions relating to a person with MRSA. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (During this inspection we noted a number of improvements. A plumber was at the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (home replacing two wash basins which had been out of use when we were at the home )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (in February and there were new pedal bins, paper towels and hand wash in bathrooms )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (and toilets. We saw that some toilet rolls were still propped on skirting boards rather )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (than being on holders. Six more staff had been enrolled on infection control training )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (and the information about precautions for infection control relating to MRSA had been )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (addressed. Generally we found that staff were more aware than before. We therefore )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (considered that the requirements of the notice had been met.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (We found some cleaning products which were not safely stored; these were containers )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (of bleach, Milton and washing powder all of which were easily accessible to residents. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (This carries the risk of them being swallowed by someone with limited understanding )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (due to dementia. We made an immediate requirement for cleaning products to be )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (stored safely and Mr Ubhee wrote to us to confirm he had put this right. We went back )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (and checked the work done and found that items were no longer in unlocked )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (cupboards and that a lock had been fitted to the laundry door. This requirement was )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (therefore met.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (On the lower ground floor a small sluice room has been created. We saw that this )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (contains a 'butler' style sink and a flushable toilet pan. There was no wash hand basin )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (or hand cleansing gel in this room. This does not appear to be an adequate facility )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (because staff who are emptying commodes and washing them need to be able to wash )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (their hands before doing something else. The floor of the sluice is unsealed concrete )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (which would prevent effective cleaning of spillages. We are making a requirement that )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm (guidance is sought regarding facilities required in a sluice room. We would suggest )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (that the owners approach the Health Protection Agency regarding this.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (Very soon after the inspection we received a complaint that many staff are unaware of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm (the fire procedures. In the light of this and other matters described in the staffing and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm (management sections of this report, we made a referral to Hereford and Worcester )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (Fire and Rescue Service. They did their own inspection and this highlighted )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm (shortcomings including a number of fire doors being inadequate due to missing smoke )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (and heat resistant seals. We say more about this in the management section of this )Tj ET endstream endobj 66 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 67 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (27)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 41.37 w 33.45 790.72 m 563.65 790.72 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 20 w 32.32 778.91 m 564.78 778.91 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 766.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 766.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 767.79 m 566.98 767.79 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (report.)Tj ET endstream endobj 68 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 69 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (28)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 768.13 Tm (Staffing)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 12 Tf BT 1 0 0 1 28.35 747.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.81 Tm (These are the outcomes that people )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 730.81 Tm (staying in care homes)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 730.81 Tm ( should experience. They )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 713.31 Tm (reflect the things that people have said are important to them:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 700.85 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 104.25 w 32.32 644.29 m 562.53 644.29 l S 0.001 w 1 1 1 RG 17 w 31.2 601.79 m 563.65 601.79 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 611.42 m 565.85 611.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 698.67 m 565.85 698.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 611.42 m 565.85 611.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 592.17 m 565.85 592.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 699.74 m 30.07 591.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 699.74 m 564.78 591.09 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 685.48 Tm (People have safe and appropriate support as there are enough competent staff on duty )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.48 Tm (at all times. They have confidence in the staff at the home because checks have been )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.48 Tm (done to make sure that they are suitable to care for them. Their needs are met and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.48 Tm (they are cared for by staff who get the relevant training and support from their )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 617.48 Tm (managers.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 598.23 Tm (There are no additional outcomes.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 573.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 551.86 Tm (This is what people )Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 148.49 551.86 Tm (staying in this care home)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 305.46 551.86 Tm (experience)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 370.91 551.86 Tm (:)Tj ET /F6 8 Tf BT 1 0 0 1 28.35 534.68 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 154.97 w 33.45 453.25 m 563.65 453.25 l S 0.001 w 1 1 1 RG 22.5 w 31.2 521.73 m 565.9 521.73 l S 0.001 w 132.47 w 32.32 442 m 564.78 442 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 509.36 m 566.98 509.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 510.44 m 31.2 373.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 510.44 m 565.9 373.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 509.36 m 565.9 509.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 374.64 m 566.98 374.64 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 518.42 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 493.68 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 258.02 493.68 Tm (poor)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 289.42 493.68 Tm (quality outcomes in this area. We have made )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 476.18 Tm (this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 456.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 436.19 Tm (People at Abbey Grange are cared for by hard working and caring staff but are not )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 418.69 Tm (supported by effective management and leadership or by well planned training )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 401.2 Tm (arrangements. People are not adequately protected from the risk of unsuitable people )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 383.7 Tm (being employed due to inadequate recruitment procedures.)Tj ET 0.99608 0.9451 0.76078 RG 280.54 w 33.45 208.5 m 563.65 208.5 l S 0.001 w 1 1 1 RG 22.5 w 31.2 339.77 m 565.9 339.77 l S 0.001 w 259.17 w 32.32 196.69 m 564.78 196.69 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 327.4 m 566.98 327.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 328.47 m 31.2 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 328.47 m 565.9 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 327.4 m 565.9 327.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 65.97 m 566.98 65.97 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 336.46 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 311.71 Tm (We consistently receive positive feedback about the staff who work at Abbey Grange. )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 294.22 Tm (People who live there and their families speak highly of them and find them caring and )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 276.72 Tm (friendly. In our recent surveys people said things such as - " They are very helpful and )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 259.22 Tm (friendly and keen to help at all times", "Very kind and caring staff", "The staff are very )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 241.73 Tm (kind, warm and genuinely caring and patient, in often difficult circumstances".)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 224.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 206.74 Tm (Staffing arrangements on the day we inspected were affected by a number of staff )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 189.24 Tm (going on a training course in Swansea. When we arrived the manager was on duty )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 171.74 Tm (with two care staff and a cook. He told us that the cleaner and some of the care staff )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 154.25 Tm (who would have worked that day had gone on the training. He told us he was )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 136.75 Tm (expecting another member of staff but she had not arrived yet. When this person )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 119.26 Tm (arrived at 10:15am we found that it was not a member of staff employed at Abbey )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 101.76 Tm (Grange but the manager of another care home owned by a company of which Mr )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 84.26 Tm (Ubhee is a director. The rota was not accurate because it showed the names of some )Tj ET endstream endobj 70 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 71 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (29)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 742.05 w 33.45 440.38 m 563.65 440.38 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 720.68 w 32.32 428.57 m 564.78 428.57 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.1 m 566.98 67.1 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (staff who were on this training as working on shift at the home. Whilst it was positive )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (that an extra person was brought in this raises a concern about how Mr Ubhee plans )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (training to make sure the home remains adequately staffed.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (Our observations during the meal at lunch time led us to conclude that staffing levels )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (were not sufficient to give people at the home enough support and assistance with )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (eating their meal. When we spoke to Mr Ubhee about staffing levels he indicated that )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (there were problems at present due to one person in particular needing a lot of time. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (He said he has told the person's relatives that she may need to move or that they will )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (need to pay a higher fee so he can provide more staff. This is another indicator that )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (the home is not equipped to provide a service for people who have care needs related )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (to dementia. Our concerns about staffing levels are added to because there is no )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (designated laundry worker so care staff have to fit in doing the laundry around their )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (other duties. We are aware that on occasions care staff also do cleaning and catering )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (duties during their shift.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (When we spoke to Mr Ubhee about the statement in the AQAA that staffing levels are )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (determined by resident need he was unable to show us how he arrives at the staffing )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (levels needed.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (The induction training being provided at the home is not based on the national )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (standards set out by Skills for Care although Mr Ubhee told us that the NVQ training )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (staff are doing is provided by Herefordshire PCT. One of the staff we spoke to was )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (fairly new; she had not done structured induction training and was unaware that there )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (are national induction standards for carer workers.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (We had some difficulty in reconciling the staff training matrix \(which shows the topics )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (staff have been trained in\) with the certificates in their staff files. For example, one )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (person was shown on the matrix as having done induction, infection control and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (dementia but there were no certificates for these in the file. The same person told us )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (she had not had medication training although this was also shown on the matrix. One )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (problem we encountered was that some staff were shown on the matrix as having )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm (done medication training but the certificates for the corresponding date were for )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm ('Introduction to care'. Mr Ubhee told us he was sure the training on this date was )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm (medication. We have since contacted the training provider and they confirmed that )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (they issued the wrong certificates to the home. This is something Mr Ubhee should )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm (have identified and followed up himself when the certificates arrived.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (We are aware that Mr Ubhee has been arranging more staff training since we did our )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm (inspection in October 2008 and during this site visit we took note of information on the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (noticeboards about forthcoming training. However, it was difficult to get a )Tj ET endstream endobj 72 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 73 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (30)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 742.05 w 33.45 440.38 m 563.65 440.38 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 720.68 w 32.32 428.57 m 564.78 428.57 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.1 m 566.98 67.1 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (comprehensive picture of staff training due to the contradictory information and Mr )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (Ubhee's lack of availability on the day. Overall we remain concerned that the home )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (does not have effective arrangements for monitoring staff training needs and keeping )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (track of when updates are needed. We also found it hard to establish who the various )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (training courses are provided by. We spoke to Swansea local authority to check the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (authenticity of some of the training certificates we saw at the home. We did this )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (because the course title was handwritten by the staff who did the training. They said )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (this is how they provide certificates for large training sessions but expressed concern )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (that Hereford staff had attended. They said the training they provide is aimed at staff )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (who work in care services in the Swansea area and are often oversubscribed. They )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (said they would not knowingly give places to staff from another area.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (We have had particular concerns about dementia care training for staff at the home. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (When we inspected in February we were given a staff matrix showing that two staff )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (were doing dementia training \(on a distance learning course\) and that two others had )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (also done dementia training. We made a requirement for training to be arranged for )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (other staff and during this site visit saw that ten staff started a course in March. Two )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (relatives who sent surveys to us made comments about the need for dementia training )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (for staff.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (Some staff also highlighted the need for training in respect of activities for people at )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm (the home, for example one wrote - " Although the care staff are doing their best to do )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (this, it would still make a difference to have a qualified activity co-coordinator as )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (he/she can fully assess what sort of activities is suitable for the residents.")Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (The training matrix shows there are still some significant gaps in essential staff )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (training. For example, in the week we did our site visit there were four night shifts )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (when none of the staff from 8pm to 8am had done first aid training; three of the four )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (staff who work nights have not done infection control training; nine staff had not done )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (fire safety training and five staff had not done moving and handling training. We say )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (more about management of safety in the home in the management section of this )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (report.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (When we inspected in October 2008 we were concerned that the home had inadequate )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm (staff recruitment arrangements and made a requirement for them to improve these; in )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (particular we told them they must do the checks required by law to make sure people )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm (are suitable to be employed as care workers. When we checked this again in February )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm (we found that some essential checks had still not been done. We therefore issued a )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (statutory requirement notice. During this site visit we found that some staff files were )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm (still incomplete and that essential checks that the law requires such as criminal records )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (checks and references were not available. This meant that the statutory requirement )Tj ET endstream endobj 74 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 75 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (31)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 76.36 w 33.45 773.22 m 563.65 773.22 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 54.99 w 32.32 761.41 m 564.78 761.41 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 731.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 731.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 732.79 m 566.98 732.79 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (notice had not been complied with. Due to the home's continued failure to comply with )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (Regulations and the possible risks to people who reside at Abbey Grange further )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (enforcement action is being considered by CQC.)Tj ET endstream endobj 77 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 78 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (32)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 768.13 Tm (Management and administration)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 12 Tf BT 1 0 0 1 28.35 747.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.81 Tm (These are the outcomes that people )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 730.81 Tm (staying in care homes)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 730.81 Tm ( should experience. They )Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 713.31 Tm (reflect the things that people have said are important to them:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 700.85 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 189.25 w 32.32 601.79 m 562.53 601.79 l S 0.001 w 1 1 1 RG 102 w 31.2 559.29 m 563.65 559.29 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 611.42 m 565.85 611.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 698.67 m 565.85 698.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 611.42 m 565.85 611.42 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 507.17 m 565.85 507.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 699.74 m 30.07 506.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 699.74 m 564.78 506.09 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 685.48 Tm (People have confidence in the care home because it is led and managed appropriately. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.48 Tm (People control their own money and choose how they spend it. If they or someone )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.48 Tm (close to them cannot manage their money, it is managed by the care home in their )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.48 Tm (best interests. The environment is safe for people and staff because appropriate health )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 617.48 Tm (and safety practices are carried out.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 598.23 Tm (People get the right support from the care home because the manager runs it )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 581.23 Tm (appropriately with an open approach that makes them feel valued and respected. The )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 564.23 Tm (people staying at the home are safeguarded because it follows clear financial and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 547.23 Tm (accounting procedures, keeps records appropriately and ensures their staff understand )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 530.23 Tm (the way things should be done. They get the right care because the staff are )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 513.23 Tm (supervised and supported by their managers.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 488.91 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 466.86 Tm (This is what people )Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 148.49 466.86 Tm (staying in this care home)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 305.46 466.86 Tm (experience)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 370.91 466.86 Tm (:)Tj ET /F6 8 Tf BT 1 0 0 1 28.35 449.68 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 154.97 w 33.45 368.25 m 563.65 368.25 l S 0.001 w 1 1 1 RG 22.5 w 31.2 436.73 m 565.9 436.73 l S 0.001 w 132.47 w 32.32 357 m 564.78 357 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 424.36 m 566.98 424.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 425.44 m 31.2 288.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 425.44 m 565.9 288.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 424.36 m 565.9 424.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 289.64 m 566.98 289.64 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 433.42 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 408.68 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 258.02 408.68 Tm (poor)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 289.42 408.68 Tm (quality outcomes in this area. We have made )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 391.18 Tm (this judgement using a range of evidence, including a visit to this service.)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 371.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.47 351.19 Tm (People who live at Abbey Grange do not benefit from a well managed service with )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 333.69 Tm (effective leadership to staff. The manager is at the home for less than half the week )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 316.2 Tm (which means that staff do not have the expected support and guidance to provide the )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 298.7 Tm (best possible service.)Tj ET 0.99608 0.9451 0.76078 RG 195.54 w 33.45 166 m 563.65 166 l S 0.001 w 1 1 1 RG 22.5 w 31.2 254.77 m 565.9 254.77 l S 0.001 w 174.17 w 32.32 154.19 m 564.78 154.19 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 242.4 m 566.98 242.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 243.47 m 31.2 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 243.47 m 565.9 64.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 242.4 m 565.9 242.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 65.97 m 566.98 65.97 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 251.46 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 35.47 226.71 Tm (Mr Ubhee is the joint owner \(with his wife\) of Abbey Grange and is the person who )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 209.22 Tm (manages the home. The legal requirement is for a person to be in day to day charge of )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 191.72 Tm (a care home. If they are not or do not intend to be, the law says they must appoint a )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 174.22 Tm (manager. Mr Ubhee chooses to work his hours over three long days and is therefore )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 156.73 Tm (absent for four days a week. We have had information from a range of different )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 139.23 Tm (sources that he has been at Abbey Grange less than that although is now spending )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 121.74 Tm (more time there. In view of the concerns identified in this and previous reports we are )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 104.24 Tm (unconvinced that the current arrangement is satisfactory and have made a )Tj ET /F2 12 Tf BT 1 0 0 1 35.47 86.74 Tm (recommendation that Mr Ubhee reviews this working pattern.)Tj ET endstream endobj 79 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 80 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (33)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 742.05 w 33.45 440.38 m 563.65 440.38 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 720.68 w 32.32 428.57 m 564.78 428.57 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.1 m 566.98 67.1 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (We have concerns about the level of ability of staff given the responsibility of being in )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (charge when the manager is not there. Some of the information we received from staff )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (echoed our views about the the lack of adequate management. Some of the comments )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm (included - " There should be a deputy manager who can oversee the needs of the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (home if ever the manager is not there", "I think Abbey Grange could do better if there )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (is a deputy manager who would take the place and responsibilities in the absence of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (the registered manager". Mr Ubhee told us he is intending to appoint a deputy )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (manager and is also considering recruiting someone as a new manager so that he )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (would only have his responsibilities as owner to fulfill. We were concerned that the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm (person Mr Ubhee was considering as deputy has limited care experience but he )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (assured us that she is undertaking a comprehensive training programme first.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm (Mr Ubhee is shown on the staff training matrix but there are no entries against his )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (name for any training topics other than an infection control course in 2007 and his )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (enrollment on an infection control distance learning course in February 2009. There is )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (no date shown against his name for dementia training. It is a legal requirement for )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (owners of care services to undertaken training to ensure they have the knowledge and )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (skills required for their role. We did not have the opportunity to discuss this with Mr )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (Ubhee during the inspection but have made a recommendation for information about )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (the training he has done to be available for inspection at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (We have had information from several unconnected sources that people are concerned )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (about the manner in which Mr Ubhee treats staff who work at the home. We have )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (been told that he looses his temper with them and 'bullies' them. Mr Ubhee has denied )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (this allegation. We have not witnessed this first hand but have found him unhelpful on )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (occasions. For example, during our site visit he frequently left the room in the middle )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (of us discussing things with him and on several occasions we needed to go and find )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (him when we were expecting him to return quickly. This meant the inspection took )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (longer than it needed to and that we were unable to discuss many issues with Mr )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (Ubhee. Staff from Herefordshire Council have had similar experiences during meetings )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (about people's care.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (There are no structured quality assurance measures in place at the home. In the AQAA )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm (the owners told us they have meetings with relatives every three months but when we )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (asked to see information about these Mr Ubhee told us these are informal social events )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm (with no records kept. We looked at a folder containing thank you cards and letters. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm (These showed that many people had been pleased with the care that they or their )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (relatives had received. A number of the surveys we had from relatives gave a positive )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm (view of the home and some specifically said they did not feel that the report on our )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (previous key inspection in October gave a picture of the home as they see it. We )Tj ET endstream endobj 81 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 82 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (34)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 0.99608 0.9451 0.76078 RG 741.21 w 33.45 440.8 m 563.65 440.8 l S 0.001 w 1 1 1 RG 22.5 w 31.2 802.41 m 565.9 802.41 l S 0.001 w 719.84 w 32.32 428.99 m 564.78 428.99 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 30.12 790.03 m 566.98 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 791.11 m 31.2 66.87 l S 0.001 w [] 0 d [] 0 d 2.25 w 565.9 791.11 m 565.9 66.87 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 790.03 m 565.9 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 67.95 m 566.98 67.95 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 779.1 Tm (believe that the explanation for this may be that for some people care at the home )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 761.6 Tm (does meet their needs but this is not the case for all. In addition, some of the issues )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 744.11 Tm (we have identified would not be visible to people visiting. For example, they would be )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 726.61 Tm (unaware of the issues regarding staff recruitment procedures and fire safety.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 709.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 691.62 Tm (We checked the records and storage of spending money for people the home keeps )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 674.12 Tm (small amounts for. With the exception of one minor error the amounts held reconciled )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 656.63 Tm (correctly with the records. Mr Ubhee told us he was in the process of making )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 639.13 Tm (arrangements to make sure this money would be available on request for people when )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 621.63 Tm (he is not there with the key. We had made a recommendation about this in October.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 604.14 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 586.64 Tm (Mr Ubhee has introduced a system of staff supervision and is keeping records of this. )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 569.15 Tm (This is a positive step which should help to build the effectiveness of the staff team.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 551.65 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 534.15 Tm (We have spoken about the improvements in the records relating to individual people's )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 516.66 Tm (care and we also found improvements in the way staff files were organised. However, )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 499.16 Tm (the level of organisation in Mr Ubhee's office and in the two staff workstations needs to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 481.67 Tm (be improved. This would benefit the overall efficiency and effectiveness of how the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 464.17 Tm (home is run. For example, in Mr Ubhee's office there were piles of files and papers on )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 446.67 Tm (surfaces, on a sofa and on the floor. This level of disorganisation carries the risk of )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 429.18 Tm (information being being lost.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 394.19 Tm (Mr Ubhee needs to address a number of areas related to the safety of the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 376.69 Tm (accommodation and the training of staff in health and safety topics. The report done )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 359.19 Tm (by the fire service highlighted that as well as some fire doors providing inadequate )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 341.7 Tm (protection the fire risk assessment for the home was also inadequate. They found that )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 324.2 Tm (it was inadequate, out of date and had not been reviewed or updated since 2006. They )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 306.71 Tm (also identified that staff fire training was inadequate. The fire service are returning to )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 289.21 Tm (the home in September to check that the requirements they made have been met. We )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 271.71 Tm (have taken note of Mr Ubhee's response to the complaint we received about staff not )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 254.22 Tm (knowing fire safety procedures. This said that some staff would be doing training on )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 236.72 Tm (23rd June and others as soon as this could be arranged. The information in his letter )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 219.23 Tm (about staff who did training in August 2008 was different from the information on the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 201.73 Tm (training matrix given to us at the inspection.)Tj ET /F2 12 Tf BT 1 0 0 1 33.22 184.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 33.22 166.74 Tm (During our site visit we found unsecured cleaning materials and unlocked doors to the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 149.24 Tm (boiler room and linen store, both of which had signs to say they should be locked. The )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 131.75 Tm (staff matrix shows that there are numbers of staff who still need training in topics such )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 114.25 Tm (as first aid, fire safety, food hygiene and moving and handling. More positively, the )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 96.75 Tm (home received a 3 star 'good' food hygiene rating from Herefordshire Council )Tj ET /F2 12 Tf BT 1 0 0 1 33.22 79.26 Tm (Environmental Health Department.)Tj ET endstream endobj 83 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 84 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 56.81 m 566.93 56.81 l S 0.001 w /F2 11 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 53.04 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 53.04 Tm (Page )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 53.04 Tm (35)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 526.07 53.04 Tm (of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 53.04 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr endstream endobj 85 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 87 0 obj 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the National Minimum Standards.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 638.17 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 635.17 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 635.17 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 635.17 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 635.17 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 623.02 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 603.61 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 600.61 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 600.61 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 600.61 Tm (The service must make )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 586.03 Tm (arrangements to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 571.45 Tm (medication administration )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 556.87 Tm (records are accurately )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 542.29 Tm (maintained.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 524.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 510.13 Tm (This is to prevent a )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 495.55 Tm (medication error that may )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 480.97 Tm (cause harm to a resident.)Tj ET /F2 12 Tf BT 1 0 0 1 478.9 600.61 Tm (30/04/2009)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 461.14 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 458.14 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 458.14 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 458.14 Tm (The service must make )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 443.56 Tm (arrangements to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 428.98 Tm (there are records for )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 414.4 Tm (medicines documenting what )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 399.82 Tm (medication is stored and )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 385.24 Tm (available within the service, )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 370.66 Tm (including receipt, )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 356.08 Tm (administration and disposal )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 341.5 Tm (records.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 323.92 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 309.34 Tm (This is in order to ensure )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 294.76 Tm (that the residents medication )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 280.18 Tm (needs are being )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 265.6 Tm (safeguraded.)Tj ET /F2 12 Tf BT 1 0 0 1 478.9 458.14 Tm (30/04/2009)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 245.77 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 242.77 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 242.77 Tm (19)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 242.77 Tm (You must ensure that all the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 228.19 Tm (information specified in this )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 213.61 Tm (Regulation is secured to )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 199.03 Tm (determine the fitness of )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 184.45 Tm (employees working at the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 169.87 Tm (home.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 152.29 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 137.71 Tm (This will help to prevent )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 123.13 Tm (unsuitable staff being )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 108.55 Tm (employed.)Tj ET /F2 12 Tf BT 1 0 0 1 478.9 242.77 Tm (31/12/2008)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 88.72 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 85.72 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 85.72 Tm (19)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 85.72 Tm (You must ensure that in )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 71.14 Tm (respect of all people )Tj ET /F2 12 Tf BT 1 0 0 1 478.9 85.72 Tm (27/03/2009)Tj ET endstream endobj 88 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 89 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (37)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 198.54 w 31.2 713.26 m 91.05 713.26 l S 0.001 w 198.54 w 93.3 713.26 m 197.4 713.26 l S 0.001 w 198.54 w 199.65 713.26 m 289.45 713.26 l S 0.001 w 198.54 w 291.7 713.26 m 473.8 713.26 l S 0.001 w 198.54 w 476.05 713.26 m 566.1 713.26 l S 0.001 w 227.7 w 31.2 497.89 m 91.05 497.89 l S 0.001 w 227.7 w 93.3 497.89 m 197.4 497.89 l S 0.001 w 227.7 w 199.65 497.89 m 289.45 497.89 l S 0.001 w 227.7 w 291.7 497.89 m 473.8 497.89 l S 0.001 w 227.7 w 476.05 497.89 m 566.1 497.89 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 612.86 m 568.3 612.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.3 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 612.86 m 568.3 612.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 382.91 m 568.3 382.91 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 381.84 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 814.73 m 92.17 381.84 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 814.73 m 198.52 381.84 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 814.73 m 290.57 381.84 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 814.73 m 474.92 381.84 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 814.73 m 567.22 381.84 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 292.3 802.72 Tm (employed at the care home )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 788.14 Tm (all relevant information and )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 773.56 Tm (documents as required by )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 758.98 Tm (Regulation 19 of the Care )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 744.4 Tm (Homes Regulations 2001 is )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 729.82 Tm (sought and available for )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 715.24 Tm (inspection.)Tj ET /F2 12 Tf BT 1 0 0 1 292.3 694.66 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 292.3 680.08 Tm (To help protect people living )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 665.5 Tm (in the home from unsuitable )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 650.92 Tm (staff being employed. We )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 636.34 Tm (have issued a statutory )Tj ET /F2 12 Tf BT 1 0 0 1 292.3 621.76 Tm (notice about this.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 599.68 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 596.68 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 596.68 Tm (19)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 596.68 Tm (Where people are employed )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 582.1 Tm (to work at the home with a )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 567.52 Tm (POVA 1st check ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 552.94 Tm (appropriate arrangements )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 538.36 Tm (are put in place to ensure )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 523.78 Tm (that they work in accordance )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 509.2 Tm (with Regulation 19\(11\) of the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 494.62 Tm (Care Homes Regulations )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 480.04 Tm (2001. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 462.46 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 447.88 Tm (To help protect people living )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 433.3 Tm (in the home from unsuitable )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 418.72 Tm (staff being employed. We )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 404.14 Tm (have issued a statutory )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 389.56 Tm (notice about this.)Tj ET /F2 12 Tf BT 1 0 0 1 478.9 596.68 Tm (27/03/2009)Tj ET endstream endobj 90 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 91 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (38)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 797.57 Tm (Requirements and recommendations from this inspection:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 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583.31 m 568.4 583.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 550.76 m 568.3 550.76 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 259.51 m 568.3 259.51 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 61.78 m 568.3 61.78 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 653.38 m 30.07 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 551.84 m 92.17 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 584.39 m 198.52 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 551.84 m 290.57 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 551.84 m 474.92 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 653.38 m 567.32 60.7 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 639.11 Tm (Statutory requirements)Tj ET 0.99216 0.89804 0.5451 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 619.11 Tm (These requirements set out what the registered person must do to meet the Care )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 604.53 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 604.53 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 589.95 Tm (Standards. 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(reflect the type and level of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 418.57 Tm (care that the home is set up )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 401.57 Tm (to be able to provide.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 384.57 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 367.57 Tm (This is to ensure that the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 350.57 Tm (home has clear and realistic )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 333.57 Tm (aims for the needs that can )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 316.57 Tm (be properly catered for at )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 299.57 Tm (the home and so people )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 282.57 Tm (thinking of living there know )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 265.57 Tm (what they can expect.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 537.57 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 537.57 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 246.32 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 246.32 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 246.32 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 246.32 Tm (Regulation 12\(1\))Tj ET /F2 12 Tf BT 1 0 0 1 298.05 229.32 Tm (You must have reliable )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 212.32 Tm (arrangements in place for )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 195.32 Tm (providing the personal care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 178.32 Tm (needed by each person )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 161.32 Tm (living in the home. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 144.32 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 127.32 Tm (This is to ensure that each )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 110.32 Tm (person has their individual )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 93.32 Tm (care needs noticed and dealt )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 76.32 Tm (with promptly and in the )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 246.32 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 246.32 Tm ()Tj ET endstream endobj 92 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 93 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (39)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 51 w 31.2 787.03 m 91.05 787.03 l S 0.001 w 51 w 93.3 787.03 m 197.4 787.03 l S 0.001 w 51 w 199.65 787.03 m 289.45 787.03 l S 0.001 w 51 w 291.7 787.03 m 473.8 787.03 l S 0.001 w 51 w 476.05 787.03 m 566.1 787.03 l S 0.001 w 306 w 31.2 606.28 m 91.05 606.28 l S 0.001 w 306 w 93.3 606.28 m 197.4 606.28 l S 0.001 w 306 w 199.65 606.28 m 289.45 606.28 l S 0.001 w 306 w 291.7 606.28 m 473.8 606.28 l S 0.001 w 306 w 476.05 606.28 m 566.1 606.28 l S 0.001 w 170 w 31.2 366.03 m 91.05 366.03 l S 0.001 w 170 w 93.3 366.03 m 197.4 366.03 l S 0.001 w 170 w 199.65 366.03 m 289.45 366.03 l S 0.001 w 170 w 291.7 366.03 m 473.8 366.03 l S 0.001 w 170 w 476.05 366.03 m 566.1 366.03 l S 0.001 w 204 w 31.2 176.78 m 91.05 176.78 l S 0.001 w 204 w 93.3 176.78 m 197.4 176.78 l S 0.001 w 204 w 199.65 176.78 m 289.45 176.78 l S 0.001 w 204 w 291.7 176.78 m 473.8 176.78 l S 0.001 w 204 w 476.05 176.78 m 566.1 176.78 l S 0.001 w [] 0 d 2.25 w 0.99216 0.89804 0.5451 RG 28.99 760.4 m 568.3 760.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 452.15 m 568.3 452.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 279.9 m 568.3 279.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.3 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 760.4 m 568.3 760.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 452.15 m 568.3 452.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 279.9 m 568.3 279.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 73.65 m 568.3 73.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 72.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 814.73 m 92.17 72.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 814.73 m 198.52 72.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 814.73 m 290.57 72.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 814.73 m 474.92 72.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 814.73 m 567.22 72.58 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 295.8 802.72 Tm (way best suited to them as )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 785.72 Tm (identified in their )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 768.72 Tm (assessment and care plan.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 747.22 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 747.22 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 747.22 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 747.22 Tm (Regulation 13\(2\)You must )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 730.22 Tm (ensure that effective )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 713.22 Tm (arrangements are in place )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 696.22 Tm (for the stock control of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 679.22 Tm (medication and for ensuring )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 662.22 Tm (that people reliably receive )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 645.22 Tm (the medication prescribed )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 628.22 Tm (for them.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 611.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.22 Tm (This is to make sure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.22 Tm (you do not run out of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.22 Tm (people's medication and so )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.22 Tm (that people can be confident )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.22 Tm (that you will give them the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.22 Tm (medication prescribed fro )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.22 Tm (them by their general )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.22 Tm (practitioner or other health )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.22 Tm (professionals.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 747.22 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 747.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 438.97 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 438.97 Tm (10)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 438.97 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 438.97 Tm (Regulation 12\(4\))Tj ET /F2 12 Tf BT 1 0 0 1 298.05 421.97 Tm (You must make facilities )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 404.97 Tm (available for private )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 387.97 Tm (discussions, reviews, health )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 370.97 Tm (consultations etc.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 353.97 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 336.97 Tm (This is to make sure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 319.97 Tm (people living at the home )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 302.97 Tm (have their dignity and right )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 285.97 Tm (to privacy upheld.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 438.97 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 438.97 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 266.72 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 266.72 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 266.72 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 266.72 Tm (Regulation 12\(3\))Tj ET /F2 12 Tf BT 1 0 0 1 298.05 249.72 Tm (In addition to your set list of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 232.72 Tm (activities you must take )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 215.72 Tm (steps to find out what )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 198.72 Tm (people's individual )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 181.72 Tm (preferences are for how they )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 164.72 Tm (would like to spend their )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 147.72 Tm (time.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 130.72 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 113.72 Tm (This is to give people chance )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 96.72 Tm (to spend time doing things )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 79.72 Tm (that they enjoy.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 266.72 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 266.72 Tm ()Tj ET endstream endobj 94 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 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298.05 681.47 Tm (each person is given the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 664.47 Tm (support they need to eat )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 647.47 Tm (their meals so that their )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 630.47 Tm (nutritional needs are met.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 800.47 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 800.47 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 611.22 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 611.22 Tm (15)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 611.22 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 611.22 Tm (Regulation 12\(2\))Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.22 Tm (You must provide people )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.22 Tm (who live at Abbey Grange )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.22 Tm (with opportunities for )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.22 Tm (influencing the range of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.22 Tm (meals provided.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.22 Tm (This is to give people a say )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.22 Tm (over this important aspect of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.22 Tm (their lives and to improve )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 441.22 Tm (the choice available to them.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 611.22 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 611.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 421.97 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 421.97 Tm (18)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 421.97 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 421.97 Tm (Regulation 13\(6\))Tj ET /F2 12 Tf BT 1 0 0 1 298.05 404.97 Tm (Mr Ubhee must do up to )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 387.97 Tm (date safeguarding training )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 370.97 Tm (and we strongly recommend )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 353.97 Tm (that he does this in )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 336.97 Tm (Herefordshire.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 319.97 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 302.97 Tm (This is to make sure that the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 285.97 Tm (manager is fully conversant )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 268.97 Tm (with local multi agency )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 251.97 Tm (safeguarding procedures; )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 234.97 Tm (this will help him to make )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 217.97 Tm (sure people living at Abbey )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 200.97 Tm (Grange are properly )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 183.97 Tm (safeguarded.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 421.97 Tm (31/08/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 421.97 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 164.72 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 164.72 Tm (19)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 164.72 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 164.72 Tm (Regulation 12 \(4\))Tj ET /F2 12 Tf BT 1 0 0 1 298.05 147.72 Tm (You must provide facilities )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 130.72 Tm (for conversations \(including )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 113.72 Tm (phone calls\) about people )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 96.72 Tm (living in the home to be in )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 79.72 Tm (private.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 164.72 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 164.72 Tm ()Tj ET endstream endobj 96 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 97 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (41)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 1 1 1 RG 68 w 31.2 778.53 m 91.05 778.53 l S 0.001 w 68 w 93.3 778.53 m 197.4 778.53 l S 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(You must make )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 557.97 Tm (arrangements to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 540.97 Tm (all staff receive training in )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 523.97 Tm (health and safety related )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 506.97 Tm (topics relevent to the work )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 489.97 Tm (they do.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 472.97 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 455.97 Tm (This will ensure that the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 438.97 Tm (staff team has the necessary )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 421.97 Tm (knowledge to provide safe )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 404.97 Tm (care for people at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 574.97 Tm (30/09/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 574.97 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 385.72 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 385.72 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 385.72 Tm (24A)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 385.72 Tm (You must 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practice described in the National )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 144.31 Tm (Minimum Standards and the registered person\(s\) should consider them as a way of )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 129.73 Tm (improving their service.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 111.91 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 108.91 Tm (Refer to Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 108.91 Tm (Good Practice Recommendations)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 86.5 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 86.5 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 86.5 Tm (If you wish to continue to be registered as a service which )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 71.92 Tm (provides care for people with dementia related needs the )Tj ET endstream endobj 99 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 100 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older 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[] 0 d 2.25 w 28.99 550.37 m 568.3 550.37 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 498.38 m 568.3 498.38 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 446.39 m 568.3 446.39 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 394.4 m 568.3 394.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 393.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 814.73 m 92.17 393.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 814.73 m 198.52 393.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 814.73 m 567.22 393.33 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 200.25 802.72 Tm (service provided at the home needs to be developed in line )Tj ET /F2 12 Tf BT 1 0 0 1 200.25 788.14 Tm (with nationally recognised good practice in dementia care.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 763.06 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 763.06 Tm (19)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 763.06 Tm (If you wish to continue to be registered as a service which )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 748.48 Tm (provides care for people with dementia related needs the )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 733.9 Tm (environment of the home needs to be developed in line )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 719.32 Tm (with nationally recognised good practice in dementia care.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 696.49 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 696.49 Tm (19)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 696.49 Tm (In addition to your planning application for an additional )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 681.91 Tm (communal room you should review whether, in the short )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 667.33 Tm (term other areas of the home could be used to alleviate the )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 652.75 Tm (overcrowding in the two sitting rooms; this may in the )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 638.17 Tm (short term mean considering reducing the number of )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 623.59 Tm (people you accomodate at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 600.76 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 600.76 Tm (26)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 600.76 Tm (You should seek appropriate guidance and advice regaridng )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 586.18 Tm (infection control arrnagements at the home and in )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 571.6 Tm (particular the sluice and laundry facilities. We would )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 557.02 Tm (suggest approaching the Health Protection Agency.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 534.19 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 534.19 Tm (31)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 534.19 Tm (Mr Ubhee should have information available at the home )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 519.61 Tm (which shows the training he has undertaken and what )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 505.03 Tm (qualifications he has.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 482.2 Tm (6)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 482.2 Tm (31)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 482.2 Tm (Mr Ubhee should review his working pattern so that he )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 467.62 Tm (fulfills the requirement to be in 'full time day to day charge )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 453.04 Tm (of the care home'.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 430.21 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 430.21 Tm (37)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 430.21 Tm (A concerted effort to organise and store all the home's )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 415.63 Tm (records in a more orderly way would contribute to the )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 401.05 Tm (home being managed more efficiently.)Tj ET endstream endobj 101 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 102 0 obj <>stream 0 J 0.98431 0.78824 0.08627 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (43)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr 22.5 w 22.95 802.41 m 560.45 802.41 l S 0.001 w /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 799.09 Tm (Helpline:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 28.35 781.11 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 759.6 Tm (Telephone:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 100.11 759.6 Tm (03000 616161 or )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 739.6 Tm (Textphone:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 101.5 739.6 Tm (or )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 719.61 Tm (Email:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 71.07 719.61 Tm (enquiries@cqc.org.uk)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 699.61 Tm (Web:)Tj ET 0.98431 0.78824 0.08627 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 64.35 699.61 Tm (www.cqc.org.uk)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 679.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 659.62 Tm (We want people to be able to access this information. 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put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /quoteleft put dup 146 /quoteright put dup 147 /quotedblleft put dup 148 /quotedblright put dup 149 /bullet put dup 150 /endash put dup 151 /emdash put dup 152 /tilde put dup 153 /trademark put dup 154 /scaron put dup 155 /guilsinglright put dup 156 /oe put dup 157 /.notdef put dup 158 /.notdef put dup 159 /Ydieresis put dup 160 /space put dup 161 /exclamdown put dup 162 /cent put dup 163 /sterling put dup 164 /currency put dup 165 /yen put dup 166 /brokenbar put dup 167 /section put dup 168 /dieresis put dup 169 /copyright put dup 170 /ordfeminine put dup 171 /guillemotleft put dup 172 /logicalnot put dup 173 /hyphen put dup 174 /registered put dup 175 /overscore put dup 176 /degree put dup 177 /plusminus put dup 178 /twosuperior put dup 179 /threesuperior put dup 180 /acute put dup 181 /mu1 put dup 182 /paragraph put dup 183 /periodcentered put dup 184 /cedilla put dup 185 /onesuperior put dup 186 /ordmasculine put dup 187 /guillemotright put dup 188 /onequarter put dup 189 /onehalf put dup 190 /threequarters put dup 191 /questiondown put dup 192 /Agrave put dup 193 /Aacute put dup 194 /Acircumflex put dup 195 /Atilde put dup 196 /Adieresis put dup 197 /Aring put dup 198 /AE put dup 199 /Ccedilla put dup 200 /Egrave put dup 201 /Eacute put dup 202 /Ecircumflex put dup 203 /Edieresis put dup 204 /Igrave put dup 205 /Iacute put dup 206 /Icircumflex put dup 207 /Idieresis put dup 208 /Eth put dup 209 /Ntilde put dup 210 /Ograve put dup 211 /Oacute put dup 212 /Ocircumflex put dup 213 /Otilde put dup 214 /Odieresis put dup 215 /multiply put dup 216 /Oslash put dup 217 /Ugrave put dup 218 /Uacute put dup 219 /Ucircumflex put dup 220 /Udieresis put dup 221 /Yacute put dup 222 /Thorn put dup 223 /germandbls put dup 224 /agrave put dup 225 /aacute put dup 226 /acircumflex put dup 227 /atilde put dup 228 /adieresis put dup 229 /aring put dup 230 /ae put dup 231 /ccedilla put dup 232 /egrave put dup 233 /eacute put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B TcJ6*]h[zeKq)ƷW0jlBIf14%B[tnqNOדe{fC;1I^7^r5=[ySwF 5ZUͧ@;J7{Phx ғ*⿅΅V1lCd3Dk9+ ~Iic*x 2YC.eKgt_"t!Ztb$~iS[xdw +P7)%g9/-awT=JK/{ Q'y!kA,7 Α$?H}Om"s*5aks*HRUufn6i?kɝ=-0X%lϧQ4ݡ`rџ~D&#&:t]=.ok &DZђԺŠRq [j@3a*42K]sjϖjG_n 4Ϛ5. *Ly^w`ܮ64r/:!?u:};ߜ`dӤJY2R'wbTCI2CRNY2uD-.Y9y:2Cʸ`ͻq5dBpQŰ: TimM;f ]+ozY0,(Fh^ GirY E W| -R̵vVP ce޾'zH+1= PU~}fIa 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All Rights Reserved %%CreationDate: Thu Oct 09 15:25:10 2008 % Converted from TrueType font 'VERDANA.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 2.35) readonly def /Notice (Typeface and data 1996 Microsoft Corporation. All Rights Reserved) readonly def /FullName (Verdana) readonly def /FamilyName (Verdana) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -88 def /UnderlineThickness 59 def end readonly def /FontName /Verdana def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {-30 -207 1447 1000} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /quotedbl put dup 35 /numbersign put dup 36 /dollar put dup 37 /percent put dup 38 /ampersand put dup 39 /quotesingle put dup 40 /parenleft put dup 41 /parenright put dup 42 /asterisk put dup 43 /plus put dup 44 /comma put dup 45 /hyphen put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /at put dup 65 /A put dup 66 /B put dup 67 /C put dup 68 /D put dup 69 /E put dup 70 /F put dup 71 /G put dup 72 /H put dup 73 /I put dup 74 /J put dup 75 /K put dup 76 /L put dup 77 /M put dup 78 /N put dup 79 /O put dup 80 /P put dup 81 /Q put dup 82 /R put dup 83 /S put dup 84 /T put dup 85 /U put dup 86 /V put dup 87 /W put dup 88 /X put dup 89 /Y put dup 90 /Z put dup 91 /bracketleft put dup 92 /backslash put dup 93 /bracketright put dup 94 /asciicircum put dup 95 /underscore put dup 96 /grave put dup 97 /a put dup 98 /b put dup 99 /c put dup 100 /d put dup 101 /e put dup 102 /f put dup 103 /g put dup 104 /h put dup 105 /i put dup 106 /j put dup 107 /k put dup 108 /l put dup 109 /m put dup 110 /n put dup 111 /o put dup 112 /p put dup 113 /q put dup 114 /r put dup 115 /s put dup 116 /t put dup 117 /u put dup 118 /v put dup 119 /w put dup 120 /x put dup 121 /y put dup 122 /z put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /asciitilde put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /quotesinglbase put dup 131 /florin put dup 132 /quotedblbase put dup 133 /ellipsis put dup 134 /dagger put dup 135 /daggerdbl put dup 136 /circumflex put dup 137 /perthousand put dup 138 /Scaron put dup 139 /guilsinglleft put dup 140 /OE put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /quoteleft put dup 146 /quoteright put dup 147 /quotedblleft put dup 148 /quotedblright put dup 149 /bullet put dup 150 /endash put dup 151 /emdash put dup 152 /tilde put dup 153 /trademark put dup 154 /scaron put dup 155 /guilsinglright put dup 156 /oe put dup 157 /.notdef put dup 158 /.notdef put dup 159 /Ydieresis put dup 160 /space put dup 161 /exclamdown put dup 162 /cent put dup 163 /sterling put dup 164 /currency put dup 165 /yen put dup 166 /brokenbar put dup 167 /section put dup 168 /dieresis put dup 169 /copyright put dup 170 /ordfeminine put dup 171 /guillemotleft put dup 172 /logicalnot put dup 173 /hyphen put dup 174 /registered put dup 175 /overscore put dup 176 /degree put dup 177 /plusminus put dup 178 /twosuperior put dup 179 /threesuperior put dup 180 /acute put dup 181 /mu1 put dup 182 /paragraph put dup 183 /middot put dup 184 /cedilla put dup 185 /onesuperior put dup 186 /ordmasculine put dup 187 /guillemotright put dup 188 /onequarter put dup 189 /onehalf put dup 190 /threequarters put dup 191 /questiondown put dup 192 /Agrave put dup 193 /Aacute put dup 194 /Acircumflex put dup 195 /Atilde put dup 196 /Adieresis put dup 197 /Aring put dup 198 /AE put dup 199 /Ccedilla put dup 200 /Egrave put dup 201 /Eacute put dup 202 /Ecircumflex put dup 203 /Edieresis put dup 204 /Igrave put dup 205 /Iacute put dup 206 /Icircumflex put dup 207 /Idieresis put dup 208 /Eth put dup 209 /Ntilde put dup 210 /Ograve put dup 211 /Oacute put dup 212 /Ocircumflex put dup 213 /Otilde put dup 214 /Odieresis put dup 215 /multiply put dup 216 /Oslash put dup 217 /Ugrave put dup 218 /Uacute put dup 219 /Ucircumflex put dup 220 /Udieresis put dup 221 /Yacute put dup 222 /Thorn put dup 223 /germandbls put dup 224 /agrave put dup 225 /aacute put dup 226 /acircumflex put dup 227 /atilde put dup 228 /adieresis put dup 229 /aring put dup 230 /ae put dup 231 /ccedilla put dup 232 /egrave put dup 233 /eacute put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B Tc gPUcOx {OqqQF4-UټXODU8o\kswKami%ޗﶥB$S/1LW~'T^<T4PX+ԯ({A34.KUĖn%*R_g!g(F4%ٸD K~ɕy8e!lcx# |< -}^^i(XlŨ3K a[y3E7Oz,߉1N6+Pj)cpS-mR\7߃Ra0bRTl,SQYKO׏C8y'߭sU5d}DҰMۭT[I[(㏭AK9%+,E B`6P( :8|NoYo>XImF;:Bŀÿ Kt,!fa"X0*Im Srߋ{8w;Ҵ+DIZy41Żp m`Z# 2;7aޗ8~$6<+p Uk!i͢m~~ I[z)*a0wmNQ ^\تw?@ċ=0}Ơ6YWUfo&|*aGѤrvʧ:q9h@) 6u%sBo$N?J6(Ah:m~\ZXݐ^NR(>^;:i~f6{'Y &'W|-}犁$$S Cp`Ӎ+Wǧ`q4{W_E&9YXs1sZQ<*`(SaD~e 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Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: 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[ u}R'S;W`W^3OYEcN,&$/A90O &&!g.˚ޅהB ,x#*jMn6̰HU9͌%|mv0QU>>&9zTLJG]ˁ6=0.PKjzc ۟7]y"5zCVD't(rK!uۥe-w8=cI\AZGd!6Mel xMgh5DJxCj0=QFDO$nIxS%~Wtm?$Ӻa8#c3zω̥/b &wEMMэnŨy)e!}{5y`$[ldxNp>A.|@+j`edyeɘHjxG}i d ϕa˻y: !#F*a0SJf3J(WkS4O1^Հ3c%bL(g.s!QS+ Ui)!;*DDP=<pQUCIKSYaMBG#a!Qke ԮVV V:T \݋qnaY<[IC=ǃJ$R@N߀'pH͎{Y!^^e-8)Ic A$`KPy 5v,'w[ԜWo oP%WV8*vg i?Aא5Np+EO8Gf:f-6JK;E@wOv}w{LB{DQ/2Znf#UL8ц]Asy9$xUOg'.̺}'l68[}{."׼_N& e.%&;JL)G]VPtVZO%eznh+p갦~̱ډ o?w)+VäaOTwۑƔmwE4u*8iARNx)Df"m4%{36/« wQ43֖U/hu~Vy{ +< ^{65yyaP>g(:4xW23,f{rƝBρzWܚP$`'Iҕbu:N&f^^2em77;Lf`'l  f3|g|e;PF+gy^/K6>5// |B~eU[zr:j<C}WĆ1DY܂ڒ)Sc<6iJ$_«wDq't]{O tFU&1A%Ą7y&< PHҞĹɠ1B<>^{[4QH 1drVkyX,rs:H^zD?ـ[ d. nJώ&i\h|iAufbi;t?cL{KˍMlbTi-dߴ!_=s*dHhG8k ,H,f㳃󕴿1UozdmW&׿DOԙ20zQXH2TF &&Y*=EI`{2 G] h*V\ֳkx=_U1$ˠH;҆1*BeÔFuǝ/ـA秳pZ*ۇ{+0Ei'a{}v%}SoG߲0$iE炕/pKAVS >C_xS/KMWE/9 uqD$`l׎:D$@^P04'(ZU,uw{/U=-ü =é^ͣ5F G;W=+wf{ԗH$[sR^ ۯP^}"ZOlz9x[A5^"UN['4 *&I=H@(92(ZnVmW&l(;}}uyFex0iGC7ٿ×;."&^\$UX_vл$`,['"g[,X9< W~TAB X@;Ldk5 7ȵҺ*&0V~"])|+2)\aU|~aڍO@7Q 5 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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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