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We )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 769.53 Tm (believe high quality care should)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 749.53 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 749.53 Tm (Be safe)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 733.53 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 733.53 Tm (Have the right outcomes, including clinical outcomes)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 717.53 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 717.53 Tm (Be a good experience for the people that use it)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 701.53 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 701.53 Tm (Help prevent illness, and promote healthy, independent living)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 685.53 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 685.53 Tm (Be available to those who need it when they need it.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 651.03 Tm (The first part of the review gives the overall quality rating for the )Tj ET /F2 12 Tf BT 1 0 0 1 427.6 651.03 Tm (care home:)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 631.04 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 631.04 Tm (3 stars - excellent)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 615.04 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 615.04 Tm (2 stars - good)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 599.04 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 599.04 Tm (1 star - adequate)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 583.04 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 583.04 Tm (0 star - poor)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 551.04 Tm (There is also a bar chart that gives a quick way of seeing the quality of care that the )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 534.04 Tm (home provides under key areas that matter to people.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 500.04 Tm (There is a summary of what we think this service does well, what they have improved )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 483.04 Tm (on and, where it applies, what they need to do better.)Tj ET /F2 12 Tf BT 1 0 0 1 364.74 483.04 Tm (We use the national minimum )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 466.04 Tm (standards to describe the outcomes that people should experience.)Tj ET /F2 12 Tf BT 1 0 0 1 443.2 466.04 Tm (National minimum )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 449.04 Tm (standards are written by the Department of Health for each type of care service.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 409.54 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 28.35 392.05 Tm (what you will see under each outcome area.)Tj ET [] 0 d 0.5 w 0 0 0 RG 22.69 383.86 m 572.15 383.86 l S 0.001 w [] 0 d [] 0 d 0.5 w 22.69 50.22 m 572.15 50.22 l S 0.001 w [] 0 d [] 0 d 0.5 w 22.7 383.86 m 22.7 50.22 l S 0.001 w [] 0 d [] 0 d 0.5 w 572.15 383.86 m 572.15 50.22 l S 0.001 w [] 0 d /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 370.56 Tm (Outcome area \(for example )Tj ET 0 0 0 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 173.59 370.56 Tm (Choice of home\))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 31.2 340.26 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 1 216.34 340.26 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 1 435.79 340.26 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 31.2 328.11 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 30.6 263.37 m 562.45 263.37 l S 0.001 w 0.95294 0.95294 0.95294 RG 39.99 w 29.47 285.61 m 563.57 285.61 l S 0.001 w 1 1 1 RG 39.99 w 29.47 243.37 m 563.57 243.37 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 27.27 264.49 m 565.77 264.49 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.27 306.73 m 565.77 306.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.27 264.49 m 565.77 264.49 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.27 222.25 m 565.77 222.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.35 307.81 m 28.35 221.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.7 307.81 m 564.7 221.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.87 291.05 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 34.87 273.55 Tm (inspection)Tj ET /F2 10 Tf BT 1 0 0 1 95.78 273.55 Tm (.)Tj ET /F2 12 Tf BT 1 0 0 1 34.87 248.81 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 34.87 231.31 Tm (key inspection.)Tj ET /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 191.8 Tm (This is what people )Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 131.32 191.8 Tm (staying in this care home experience:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 28.35 154.64 Tm (Judgement:)Tj ET 1 0.9451 0.76078 RG 39.99 w 30.6 123.34 m 562.45 123.34 l S 0.001 w 1 1 1 RG 39.99 w 29.47 124.46 m 563.57 124.46 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 27.27 145.58 m 565.77 145.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.27 103.34 m 565.77 103.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.35 146.66 m 28.35 102.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.7 146.66 m 564.7 102.26 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.87 129.9 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 1 517.79 129.9 Tm (We )Tj ET /F2 12 Tf BT 1 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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 0.8 0.8 0.8 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 (61)Tj ET 0.8 0.8 0.8 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 28.35 779.1 Tm (We review the quality of the service against outcomes from the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 762.1 Tm (Standards \(NMS\).)Tj ET /F2 12 Tf BT 1 0 0 1 144.87 762.1 Tm (Those standards are written by the Department of Health for each )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 745.1 Tm (type of care service.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 705.6 Tm (Copies of the)Tj ET /F2 12 Tf BT 1 0 0 1 111.71 705.6 Tm (National Minimum Standards )Tj ET /F2 12 Tf BT 1 0 0 1 290.49 705.6 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 302.34 705.6 Tm (Care Homes for Older People)Tj ET /F2 12 Tf BT 1 0 0 1 477.18 705.6 Tm ( can be found )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 688.11 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 28.35 670.61 Tm (Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 653.11 Tm (Stationery Office is also available: )Tj ET /F2 12 Tf 0 0 1 rg BT 1 0 0 1 238.73 653.11 Tm (www.tso.co.uk/bookshop)Tj ET /F2 12 Tf 0 0 0 rg BT 1 0 0 1 28.35 613.12 Tm (The mission of the Care Quality Commission is to make care better for people by:)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 596.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 596.12 Tm (Regulating health and adult social care services to ensure quality and safety )Tj ET /F2 12 Tf BT 1 0 0 1 99.25 580.12 Tm (standards, drive improvement and stamp out bad practice)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 564.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 564.12 Tm (Protecting the rights of people who use services, particularly the most )Tj ET /F2 12 Tf BT 1 0 0 1 99.25 548.12 Tm (vulnerable and those detained under the Mental Health Act 1983)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 532.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 532.12 Tm (Providing accessible, trustworthy information on the quality of care and )Tj ET /F2 12 Tf BT 1 0 0 1 99.25 516.12 Tm (services so people can make better decisions about their care and so that )Tj ET /F2 12 Tf BT 1 0 0 1 99.25 500.12 Tm (commissioners and providers of services can improve services.)Tj ET /F4 12 Tf BT 1 0 0 1 85.05 484.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 100.35 484.12 Tm (Providing independent public accountability on how commissioners and )Tj ET /F2 12 Tf BT 1 0 0 1 99.25 468.12 Tm (providers of services are improving the quality of care and providing value )Tj ET /F2 12 Tf BT 1 0 0 1 99.25 452.12 Tm (for money.)Tj ET /F1 14 Tf BT 1 0 0 1 28.35 390.28 Tm (5HDGHU,QIRUPDWLRQ)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 28.35 368.85 m 224.05 368.85 l S 0.001 w 1 1 1 RG 20.58 w 226.3 368.85 m 567 368.85 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 28.35 346.02 m 224.05 346.02 l S 0.001 w 1 1 1 RG 20.58 w 226.3 346.02 m 567 346.02 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 28.35 323.19 m 224.05 323.19 l S 0.001 w 1 1 1 RG 20.58 w 226.3 323.19 m 567 323.19 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 28.35 300.36 m 224.05 300.36 l S 0.001 w 1 1 1 RG 20.58 w 226.3 300.36 m 567 300.36 l S 0.001 w 0.95294 0.95294 0.95294 RG 137.22 w 28.35 219.21 m 224.05 219.21 l S 0.001 w 1 1 1 RG 137.22 w 226.3 219.21 m 567 219.21 l S 0.001 w 0.95294 0.95294 0.95294 RG 38.16 w 28.35 129.27 m 224.05 129.27 l S 0.001 w 1 1 1 RG 38.16 w 226.3 129.27 m 567 129.27 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 26.14 357.43 m 569.2 357.43 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 334.6 m 569.2 334.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 311.77 m 569.2 311.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 288.94 m 569.2 288.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 149.47 m 569.2 149.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 380.26 m 569.2 380.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 357.43 m 569.2 357.43 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 334.6 m 569.2 334.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 311.77 m 569.2 311.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 288.94 m 569.2 288.94 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 149.47 m 569.2 149.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 109.06 m 569.2 109.06 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.22 381.34 m 27.22 107.99 l S 0.001 w [] 0 d [] 0 d 2.25 w 225.17 381.34 m 225.17 107.99 l S 0.001 w [] 0 d [] 0 d 2.25 w 568.12 381.34 m 568.12 107.99 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 31.2 364.08 Tm (Document Purpose)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 364.08 Tm (Inspection report)Tj ET /F2 12 Tf BT 1 0 0 1 31.2 341.25 Tm (Author)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 341.25 Tm (Care Quality Commission)Tj ET /F2 12 Tf BT 1 0 0 1 31.2 318.42 Tm (Audience)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 318.42 Tm (General public)Tj ET /F2 12 Tf BT 1 0 0 1 31.2 295.59 Tm (Further copies from)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 295.59 Tm (0870 240 7535 \(telephone order line\))Tj ET /F2 12 Tf BT 1 0 0 1 31.2 272.76 Tm (Copyright)Tj ET /F2 12 Tf BT 1 0 0 1 229.15 272.76 Tm (Copyright \(2009\) Care Quality Commission \(CQC\). )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 258.18 Tm (This publication may be reproduced in whole or in part, )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 243.6 Tm (free of charge, in any format or medium provided that )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 229.02 Tm (it is not used for commercial gain. This consent is )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 214.44 Tm (subject to the material being reproduced accurately )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 199.86 Tm (and on proviso that it is not used in a derogatory )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 185.28 Tm (manner or misleading context. The material should be )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 170.7 Tm (acknowledged as CQC copyright, with the title and date )Tj ET /F2 12 Tf BT 1 0 0 1 229.15 156.12 Tm (of publication of the document specified.)Tj ET /F2 12 Tf BT 1 0 0 1 31.2 133.29 Tm (Internet address)Tj ET /F2 12 Tf 1 0 0 rg BT 1 0 0 1 229.15 133.29 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 0.8 0.8 0.8 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 0.8 0.8 0.8 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 0.8 0.8 0.8 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 (61)Tj ET 0.8 0.8 0.8 RG 0.001 w 0 Tr /F1 14 Tf BT 1 0 0 1 28.35 795.65 Tm 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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 (Goatacre Manor Care Centre)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 (Goatacre Lane )Tj ET /F2 12 Tf BT 1 0 0 1 273.05 729.04 Tm (Goatacre)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 711.46 Tm (Wiltshire)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 693.88 Tm (SN11 9HY)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 (01249760464/454)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 (01249760252)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 (jswainson@goatacre.com)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 602.56 Tm (Provider web address:)Tj ET /F2 10 Tf BT 1 0 0 1 28.35 583.61 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 80.82 w 32.32 532.88 m 564.77 532.88 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 0.95294 0.95294 0.95294 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 0.95294 0.95294 0.95294 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 0.75294 0.75294 0.75294 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 1 355.5 559.35 Tm (Mr John O`Dea,Mrs Margaret )Tj ET /F2 12 Tf BT 1 0 0 1 355.5 544.77 Tm (O`Dea)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 (42)Tj ET /F2 10 Tf BT 1 0 0 1 28.35 480.17 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 28.35 463.17 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 63.99 w 32.32 420.85 m 564.47 420.85 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 432.26 m 567.8 432.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 455.09 m 567.8 455.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 432.26 m 567.8 432.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 388.85 m 567.8 388.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 456.17 m 30.07 387.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 298.32 433.34 m 298.32 387.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.72 456.17 m 566.72 387.77 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 438.91 Tm (Conditions of registration:)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 416.08 Tm (Category\(ies\) :)Tj ET /F2 12 Tf BT 1 0 0 1 302.3 416.08 Tm (Number of places \(if applicable\):)Tj ET /F2 12 Tf BT 1 0 0 1 302.3 395.5 Tm (Under 65)Tj ET /F2 12 Tf BT 1 0 0 1 435.37 395.5 Tm (Over 65)Tj ET 1 1 1 RG 35.16 w 31.2 366.77 m 297.3 366.77 l S 0.001 w 35.16 w 299.55 366.77 m 431.45 366.77 l S 0.001 w 35.16 w 433.7 366.77 m 565.6 366.77 l S 0.001 w 20.58 w 31.2 336.65 m 297.3 336.65 l S 0.001 w 20.58 w 299.55 336.65 m 431.45 336.65 l S 0.001 w 20.58 w 433.7 336.65 m 565.6 336.65 l S 0.001 w 20.58 w 31.2 313.82 m 297.3 313.82 l S 0.001 w 20.58 w 299.55 313.82 m 431.45 313.82 l S 0.001 w 20.58 w 433.7 313.82 m 565.6 313.82 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 31.2 290.99 m 565.6 290.99 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 348.07 m 567.8 348.07 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 325.24 m 567.8 325.24 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 302.41 m 567.8 302.41 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 279.58 m 567.8 279.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 256.75 m 568.1 256.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 219.34 m 568.1 219.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 385.48 m 567.8 385.48 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 348.07 m 567.8 348.07 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 325.24 m 567.8 325.24 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 302.41 m 567.8 302.41 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 279.58 m 568.1 279.58 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 256.75 m 568.1 256.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 219.34 m 568.1 219.34 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 196.51 m 568.1 196.51 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 386.55 m 30.07 195.43 l S 0.001 w [] 0 d [] 0 d 2.25 w 298.42 386.55 m 298.42 301.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 432.57 386.55 m 432.57 301.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.72 386.55 m 566.72 195.43 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 369.29 Tm (old age, not falling within any other )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 354.71 Tm (category)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 369.29 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 369.29 Tm (42)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 331.88 Tm (physical disability)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 331.88 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 331.88 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 309.05 Tm (terminally ill)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 309.05 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 309.05 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 286.22 Tm (Additional conditions: )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 263.39 Tm (No more than 3 persons in receipt of terminal care at any one time)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 240.56 Tm (No more than 3 physically disabled residents in the age range 18 - 64 years at any one )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 225.98 Tm (time)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 203.15 Tm (No more than 42 persons over the age of 65 years requiring nursing care)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 181.72 m 315.25 181.72 l S 0.001 w 1 1 1 RG 20.58 w 317.5 181.72 m 346.55 181.72 l S 0.001 w 20.58 w 348.8 181.72 m 377.9 181.72 l S 0.001 w 20.58 w 380.15 181.72 m 409.2 181.72 l S 0.001 w 20.58 w 411.45 181.72 m 440.55 181.72 l S 0.001 w 20.58 w 442.8 181.72 m 471.9 181.72 l S 0.001 w 20.58 w 474.15 181.72 m 503.2 181.72 l S 0.001 w 20.58 w 505.45 181.72 m 534.55 181.72 l S 0.001 w 20.58 w 536.8 181.72 m 565.9 181.72 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 193.13 m 568.1 193.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 170.3 m 568.1 170.3 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 194.21 m 30.07 169.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 316.37 194.21 m 316.37 169.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 347.67 194.21 m 347.67 169.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 379.02 194.21 m 379.02 169.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 410.32 194.21 m 410.32 169.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 441.67 194.21 m 441.67 169.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 473.02 194.21 m 473.02 169.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 504.32 194.21 m 504.32 169.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 535.67 194.21 m 535.67 169.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 194.21 m 567.02 169.23 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 176.95 Tm (Date of last inspection)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 158.43 m 565.9 158.43 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 148.8 m 568.1 148.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 149.88 m 30.07 39.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 149.88 m 567.02 39.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 168.05 m 568.1 168.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 148.8 m 568.1 148.8 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 30.07 169.13 m 30.07 147.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 169.13 m 567.02 147.73 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 154.87 Tm (Brief description of the )Tj ET /F2 12 Tf BT 1 0 0 1 177.31 154.87 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 135.62 Tm (Goatacre Manor provides accommodation and care with nursing, for up to 42 residents. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 118.62 Tm (The majority of these will be people aged 65 and over. The service may also care for )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 101.62 Tm (up to three adults in the 18 to 64 age range, if they need care due to a physical )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 84.62 Tm (disability. Both short and long-term placements can be offered. The home is privately )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 67.62 Tm (owned. The home is owned by Mr and Mrs O'Dea. The registered manager is Mrs )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 50.62 Tm (Swainson, she leads a team of registered nurses, care assistants and support staff. )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 0.8 0.8 0.8 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 0.8 0.8 0.8 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 0.8 0.8 0.8 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 (61)Tj ET 0.8 0.8 0.8 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 17 w 31.2 804.03 m 565.9 804.03 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 794.4 m 568.1 794.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 795.48 m 30.07 638.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 795.48 m 567.02 638.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.1 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 794.4 m 568.1 794.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 639.15 m 568.1 639.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 793.33 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 814.73 m 567.02 793.33 l S 0.001 w [] 0 d /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 (The home is in the small village of Goatacre, near Lyneham, Wiltshire. The market )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 766.47 Tm (towns of Calne and Wootton Bassett are within a few minutes drive. The larger town of )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 749.47 Tm (Swindon is also only a short distance away. The home consists of an original property )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 732.47 Tm (with a purpose built extension. Resident accommodation is on two floors with a )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 715.47 Tm (passenger lift in-between. There are two main lounge and dining areas, both on the )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 698.47 Tm (ground floor. The home has wheelchair suitable corridors, bedrooms and communal )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 681.47 Tm (rooms. Externally there are accessible gardens and adequate parking spaces. Fees )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 664.47 Tm (charged to service users range between 550 pounds per week to 680 pounds per )Tj ET /F2 12 Tf BT 1 0 0 1 33.25 647.47 Tm (week. A range of information for people is displayed in the entrance hall. )Tj ET endstream endobj 18 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 19 0 obj <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Length 533/Matrix [1 0 0 1 0 0]>>stream xn1 9eI J qU5ea<>vfTZߍ=s?X)9(\"j_]<7^~[-xώd\bft=|.)j(QE hHI"ͷz`5%x:z^jQ _׃:^Q؂,hnCŰ+J[ uD&,vG}!Ej+Klql=s|b `srDs 9EVՌ%rtu;:mZ4:݅6!TlYU3QPN]#];p֒]\6ٻ(9G%VՄCݏɋI\^ܝn-j:ק݁.nu"׾7;;6 ތëi:Oj,ޚ2 UN%/W9{G.3…5\x8`G-zB1L8@~~9M {QѣH i{ZKP,c3oWny~qf endstream endobj 20 0 obj<> endobj 21 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (6)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F1 14 Tf BT 1 0 0 1 28.35 795.65 Tm (6XPPDU\\)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 774.7 Tm (This is an overview of what we found during the inspection.)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 754.22 m 381.05 754.22 l S 0.001 w 1 1 1 RG 20.58 w 383.3 754.22 m 566.2 754.22 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 765.64 m 568.4 765.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 742.81 m 568.4 742.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 766.71 m 30.07 741.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 382.17 766.71 m 382.17 741.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 766.71 m 567.32 741.73 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 749.45 Tm (The quality rating for this )Tj ET /F2 12 Tf BT 1 0 0 1 191.92 749.45 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 255.59 749.45 Tm ( is:)Tj ET /F2 12 Tf BT 1 0 0 1 410.5 749.45 Tm (zero star poor service)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 717.31 Tm (2XUMXGJHPHQWIRUHDFKRXWFRPH)Tj ET /F2 10 Tf BT 1 0 0 1 212.29 641.27 Tm (Choice of home)Tj ET /F2 10 Tf BT 1 0 0 1 164.41 601.02 Tm (Health and personal care)Tj ET /F2 10 Tf BT 1 0 0 1 145.18 560.77 Tm (Daily life and social activities)Tj ET /F2 10 Tf BT 1 0 0 1 157.95 520.52 Tm (Complaints and protection)Tj ET /F2 10 Tf BT 1 0 0 1 226.36 480.27 Tm (Environment)Tj ET /F2 10 Tf BT 1 0 0 1 251.17 440.02 Tm (Staffing)Tj ET /F2 10 Tf BT 1 0 0 1 127.47 399.77 Tm (Management and administration)Tj ET q 0.75227 0 0 0.75161 305.05 334.32 cm /Xf1 Do Q 1 1 1 RG 20.58 w 31.2 283.08 m 567.85 283.08 l S 0.001 w 206.51 w 32.32 167.28 m 566.72 167.28 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.2 271.66 m 567.85 271.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 271.66 m 568.92 271.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 62.9 m 568.92 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 272.74 m 31.2 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 272.74 m 567.85 61.82 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 278.3 Tm (How we did our inspection:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 35.17 255.48 Tm (As part of this inspection, the home's file was reviewed and information provided since )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 240.9 Tm (the previous inspection considered. We also received an Annual Quality Assurance )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 226.32 Tm (Assessment \(AQAA\) from the home. This was their own assessment of how they are )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 211.74 Tm (performing. It also gave us information about what has happened during the last year. )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 197.15 Tm (We looked at the AQAA, and reviewed all the other information that we have received )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 182.57 Tm (about the home since the last inspection. This helped us to decide what we should )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 167.99 Tm (focus on during the visit to the home.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 153.41 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 138.84 Tm (As Goatacre Manor is a larger registration and issues were identified during the first )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 124.25 Tm (day of the inspection, the inspection took place over two days. One inspector )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 109.68 Tm (performed the first site visit and two inspectors the second site visit. These people are )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 95.1 Tm (referred to as "we" throughout the report, as the report is made on behalf of the Care )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 80.51 Tm (Quality Commission \(CQC\). The first site visit was on Friday 1st May 2009, between )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 65.93 Tm (9:40am and 4:10pm. The second site visit was on Friday 8th May 2009 between )Tj ET endstream endobj 22 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/XObject<>>>/MediaBox[0 0 595 842]>> endobj 23 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (7)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 294.6 w 32.32 665.23 m 566.72 665.23 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 30.12 813.65 m 568.92 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 516.8 m 568.92 516.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 814.73 m 31.2 515.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 814.73 m 567.85 515.73 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 32.92 802.72 Tm (9:30am and 1:10pm. Both site visits were unannounced. Mrs Swainson, the manager )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 788.14 Tm (was on duty for both days of the inspection. We gave Mrs Swainson a feedback at the )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 773.56 Tm (end of the inspection and gave Mr O'Dea, one of the providers, a separate feedback )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 758.98 Tm (end of the site visits, as Mrs Swainson had had to leave the home before Mr O'Dea had )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 744.4 Tm (returned.)Tj ET /F2 12 Tf BT 1 0 0 1 32.92 729.82 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 715.24 Tm (During the site visits, we met with thirteen residents, observed care for six residents )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 700.66 Tm (for whom communication was difficult and three relatives. We also received two letters )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 686.08 Tm (from residents' relatives immediately after the inspection. We toured all of the home )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 671.5 Tm (and observed care provided at different times of day and in different areas of the )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 656.92 Tm (home. We reviewed care provision and documentation in detail for five residents, )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 642.34 Tm (including a resident who had recently been admitted and considered specific matters )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 627.76 Tm (for a further three residents.)Tj ET /F2 12 Tf BT 1 0 0 1 32.92 613.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 598.6 Tm (As well as meeting with residents, we met with four registered nurses, five carers, a )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 584.02 Tm (domestic, the laundress, the administrator, the chef and the training manager. We )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 569.44 Tm (observed a lunchtime meal and activities in the sitting rooms. We reviewed systems for )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 554.86 Tm (storage of medicines and observed two medicines administration rounds. A range of )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 540.28 Tm (records were reviewed, including staff training records, five staff employment records, )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 525.7 Tm (the statement of purpose, service users' guide and maintenance records.)Tj ET endstream endobj 24 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 25 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (8)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 20.58 w 31.2 786.36 m 567.85 786.36 l S 0.001 w 297.6 w 32.32 625.02 m 566.72 625.02 l S 0.001 w 20.58 w 32.7 463.68 m 569.35 463.68 l S 0.001 w 151.8 w 33.82 375.24 m 568.22 375.24 l S 0.001 w 20.58 w 33.45 286.8 m 570.1 286.8 l S 0.001 w 210.24 w 34.57 169.15 m 568.97 169.15 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.2 774.95 m 567.85 774.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 774.95 m 568.92 774.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.12 475.1 m 568.92 475.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 776.03 m 31.2 474.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 475.1 m 569.35 475.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.7 452.27 m 569.35 452.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.62 452.27 m 570.42 452.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.62 298.22 m 570.42 298.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 275.39 m 570.1 275.39 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 298.22 m 570.1 298.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.37 275.39 m 571.17 275.39 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.37 62.9 m 571.17 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.7 453.35 m 32.7 297.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 276.47 m 33.45 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 776.03 m 567.85 474.02 l S 0.001 w [] 0 d [] 0 d 2.25 w 569.35 453.35 m 569.35 297.14 l S 0.001 w [] 0 d [] 0 d 2.25 w 570.1 276.47 m 570.1 61.82 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 781.59 Tm (What the )Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 90.52 781.59 Tm (care home)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 154.2 781.59 Tm ( does well:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 567.85 784.25 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 758.76 Tm (Goatacre is an attractive building, set in pleasant grounds, in a quiet rural village. The )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 744.18 Tm (building and grounds have a well-maintained appearance. The home benefits from )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 729.6 Tm (large, comfortable sitting/dining rooms. A wide range of equipment is provided to meet )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 715.02 Tm (the needs of people with a disability. The chef is enthusiastic about their role, is keen )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 700.44 Tm (to meet the needs of people and is prepared to work flexibly. They showed a detailed )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 685.86 Tm (individual knowledge of residents. The care and nursing staff had a pleasant manner )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 671.28 Tm (towards residents, for example at coffee time we observed staff going round offering )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 656.7 Tm (drinks in a kindly manner, gently waking people up who were asleep, chatting to )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 642.12 Tm (others, including back-chatting, to make them laugh and support them in answering.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 627.54 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 612.96 Tm (We received a range of very favourable comments about service provision. One person )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 598.38 Tm (reported "I think it's brilliant", another "I'm just lucky to be here", another "it's very )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 583.8 Tm (like being at home" and one relative reported "XX loves it". We also received )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 569.22 Tm (favourable comments about staff from people. One person said "the owners are lovely )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 554.64 Tm (people and so are all the staff", another "all I can say is this is lovely, they are so kind )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 540.06 Tm (and so good to me", another "they've gone that extra mile for us" and another "XX has )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 525.48 Tm (never been looked after so well in [the person's] life". One relative contacted us to )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 510.9 Tm (report how their relative had "benefited from the warmth and kindness" of the home. )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 496.32 Tm (Another relative contacted us to report "a more professional and caring attitude would )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 481.74 Tm (be difficult to find".)Tj ET /F2 10 Tf BT 1 0 0 1 568.97 623.47 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 461.57 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 32.7 458.91 Tm (What has improved since the last inspection?)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 569.35 462.13 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 373.69 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 436.08 Tm (The providers have made improvements to the home. This includes the entrance hall, a )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 421.5 Tm (hairdressing facility and large flat-screen televisions for sitting rooms. They have also )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 406.92 Tm (been increasing the number of en-suite facilities in residents' rooms.)Tj ET /F2 12 Tf BT 1 0 0 1 36.67 392.34 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 377.76 Tm (The home has made sure that staff now do not commence work until a satisfactory )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 363.18 Tm (result has been received from their protection of vulnerable adults list \(pova\).)Tj ET /F2 12 Tf BT 1 0 0 1 36.67 348.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 334.02 Tm (The home has started work on developing a quality assurance system, so that they can )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 319.44 Tm (review peoples' opinion about service provision and how they are complying with their )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 304.86 Tm (own polices and procedures and national guidelines.)Tj ET /F2 10 Tf BT 1 0 0 1 570.47 373.69 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 285.25 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 33.45 282.03 Tm (What they could do better:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 31.2 167.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 259.2 Tm (The home need to ensure that people are given full and accurate information about the )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 244.62 Tm (services provided, as set out in legislation and our guidelines, so that people can be )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 230.04 Tm (fully informed about if Goatacre Manor can meet their needs. The home needs to )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 215.46 Tm (ensure that full assessments of all of a prospective resident's needs are carried out )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 200.88 Tm (prior to, or at admission.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 186.3 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 171.72 Tm (Goatacre Manor needs to ensure that once people are being cared for in the home, )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 157.14 Tm (they have regular assessments of their needs, including risk to themselves presented )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 142.56 Tm (by their condition or the environment. Following assessment, care plans need to be put )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 127.98 Tm (in place for all of a person's nursing and care needs. Where relevant, care plans need )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 113.4 Tm (to confirm to local and national guidelines. Where a person's needs change, their care )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 98.82 Tm (plan needs to be up-dated. Full monitoring systems need to be put in place so that the )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 84.24 Tm (home can ensure that the needs of frail residents are being met. Resident's privacy and )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 69.66 Tm (dignity must be up-held at all times.)Tj ET endstream endobj 26 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 27 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (9)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 515.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 533.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 702.84 w 34.57 461.11 m 568.97 461.11 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 32.37 813.65 m 571.17 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.37 108.56 m 571.17 108.56 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 814.73 m 33.45 107.49 l S 0.001 w [] 0 d [] 0 d 2.25 w 570.1 814.73 m 570.1 107.49 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.17 802.72 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 788.14 Tm (The home needs to improve its systems for the management of administration of )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 773.56 Tm (medicines and be able to demonstrate that residents have been given their prescribed )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 758.98 Tm (medication. They need to ensure that all medicines are safely and appropriately stored )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 744.4 Tm (at all times. The home continues not to ensure that registered nurses are fully )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 729.82 Tm (informed about residents' needs in relation to medication prescribed on an "as )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 715.24 Tm (required" basis.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 700.66 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 686.08 Tm (The home needs to develop its approach to meeting residents' social care needs, )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 671.5 Tm (including a planned approach to the provision of activities. Care plans relating to social )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 656.92 Tm (care need to be person-centered.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 642.34 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 627.76 Tm (The inspection showed that the home are not keeping to its own stated polices and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 613.18 Tm (procedures on the management of complaints and concerns, including full )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 598.6 Tm (documentation of all matters. Some staff need to be trained in safeguarding vulnerable )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 584.02 Tm (persons and the home's procedures need to be properly developed to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 569.44 Tm (vulnerable residents are protected from risk of pressure damage. Residents also need )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 554.86 Tm (to be safeguarded from risks associated with the use of bed-rails.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 540.28 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 525.7 Tm (The home needs to improve its approach towards the prevention of spread of infection. )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 511.12 Tm (They need to ensure that equipment is regularly cleaned and any equipment which )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 496.54 Tm (cannot be cleaned is disposed of. All equipment to ensure that appropriate infection )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 481.96 Tm (control practice can be followed, needs to be provided. Risks associated with communal )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 467.38 Tm (use of a range of items including topical creams, tablets of soap, wash bowls and hoist )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 452.8 Tm (slings need to be eliminated. Improvements are needed in practice relating to the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 438.22 Tm (laundry service, so that clean and used items are fully separated, infected and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 423.64 Tm (potentially infected laundry is correctly managed and certain clothing is not used )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 409.06 Tm (communally.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 394.48 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 379.9 Tm (This inspection showed that the home continues not to ensure safe practice in the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 365.32 Tm (recruitment of staff. Newly employed staff would benefit from improvements in the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 350.74 Tm (induction system. Training in both mandatory and other areas needs development, so )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 336.16 Tm (that the home can demonstrate that staff have been trained to meet the needs of )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 321.58 Tm (residents cared for in the home. This needs to include both clear records and staff )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 307 Tm (practice when providing nursing and care.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 292.42 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 277.84 Tm (The home must ensure that they meet statutory requirements set out by us and have )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 263.26 Tm (taken good practice recommendations into account. Their quality audit systems need to )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 248.68 Tm (be robust, to ensure that quality of service provision is effectively reviewed. Major )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 234.1 Tm (improvements are needed in ensuring the health and safety of residents, particularly in )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 219.52 Tm (relation to manual handling practice, infection control practice, the use of bed rails and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 204.94 Tm (prevention of risk of scalds.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 190.36 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 175.78 Tm (We are concerned about the home's change in quality rating from a good service to a )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 161.2 Tm (poor service. We will require that they send us a plan to detail how and when they will )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 146.62 Tm (make improvements in service provision. The next inspection will take place within six )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 132.04 Tm (months and if improvements in service provision are not identified, we will take action )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 117.46 Tm (to ensure that residents' health, safety and welfare is up-held. )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 94 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 74.01 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 74.01 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 480.04 74.01 Tm ( is taking )Tj ET endstream endobj 28 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 29 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (10)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 28.35 799.09 Tm (following this report, you can contact them using the details on page 4.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 779.1 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 759.1 Tm (The report of this inspection is available from our website )Tj ET /F2 12 Tf BT 1 0 0 1 380.85 759.1 Tm (www.cqc.org.uk.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 739.11 Tm (You can get printed copies from )Tj ET /F2 12 Tf BT 1 0 0 1 225.22 739.11 Tm (enquiries@cqc.org.uk or by telephoning our)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 719.11 Tm (order line 0870 240 7535.)Tj ET endstream endobj 30 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 31 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (11)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 14 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 777.09 Tm (Details of our findings)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 26 w 31.2 744.15 m 565.9 744.15 l S 0.001 w /F1 12 Tf BT 1 0 0 1 34.05 741.14 Tm (&RQWHQWV)Tj ET 1 1 1 RG 16 w 28.35 700.15 m 566.93 700.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 696.09 Tm (Choice of home \(standards 1 - 6\))Tj ET 16 w 28.35 678.15 m 566.93 678.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 674.09 Tm (Health and personal care \(standards 7 - 11\))Tj ET 16 w 28.35 656.15 m 566.93 656.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 652.09 Tm (Daily life and social activities \(standards 12 - 15\))Tj ET 16 w 28.35 634.15 m 566.93 634.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 630.09 Tm (Complaints and protection \(standards 16 - 18\))Tj ET 16 w 28.35 612.15 m 566.93 612.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 608.09 Tm (Environment \(standards 19 - 26\))Tj ET 16 w 28.35 590.15 m 566.93 590.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 586.09 Tm (Staffing \(standards 27 - 30\))Tj ET 16 w 28.35 568.15 m 566.93 568.15 l S 0.001 w /F2 12 Tf BT 1 0 0 1 28.35 564.09 Tm (Management and administration \(standards 31 - 38\))Tj ET /F2 12 Tf BT 1 0 0 1 28.35 544.09 Tm (Outstanding statutory requirements)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 522.22 Tm (Requirements and recommendations from this inspection)Tj ET endstream endobj 33 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 36 0 obj <>stream 0 J 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Choice of home )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 206.25 w 32.32 610.38 m 562.53 610.38 l S 0.001 w 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.65 672.13 l S 0.001 w 1 1 1 RG 119 w 31.2 567.88 m 563.65 567.88 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 507.25 m 565.85 507.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 506.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 506.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 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 35.5 685.57 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 35.5 668.57 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 35.5 651.57 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 35.5 634.57 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 35.5 615.32 Tm (People can decide whether the care home can meet their support and accommodation )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 598.32 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 35.5 581.32 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 35.5 564.32 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 35.5 547.32 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 35.5 530.32 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 35.5 513.32 Tm (provides for the money.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 489 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 467 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 467 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 444.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 141.85 w 34.6 369.25 m 562.54 369.25 l S 0.001 w 1 1 1 RG 22.5 w 32.35 431.17 m 564.79 431.17 l S 0.001 w 119.35 w 33.47 358 m 563.66 358 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 418.8 m 565.87 418.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 419.88 m 32.35 296.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 419.88 m 564.79 296.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 418.8 m 564.79 418.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 297.2 m 565.87 297.2 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 427.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 403.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 403.12 Tm (poor)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 290.57 403.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 385.62 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 36.62 358.75 Tm (People will not be informed of the services offered by the home and so will not be in a )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 341.25 Tm (position to assess if the home can meet their needs. Full assessments of individuals' )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 323.76 Tm (needs are not taking place, therefore people cannot be assured that the home is in a )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 306.26 Tm (position to meet their needs.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 281.52 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 189.3 w 34.6 176.68 m 562.54 176.68 l S 0.001 w 1 1 1 RG 22.5 w 32.35 262.33 m 564.79 262.33 l S 0.001 w 167.93 w 33.47 164.87 m 563.66 164.87 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 249.96 m 565.87 249.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 251.04 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 251.04 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 249.96 m 564.79 249.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 259.02 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 234.27 Tm (The home's statement of purpose and service users' guide are both displayed in the )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 216.78 Tm (main entrance area. In their AQAA, the home reported that "the service users )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 199.28 Tm (statement makes clear what service the potential resident can expect from the home". )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 181.79 Tm (We asked the manager to give us a copy of the information, as she would to any )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 164.29 Tm (person who requested copies of the information. A home is required to have a clear )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 146.79 Tm (statement of purpose to describe the range of services offered to residents. They are )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 129.3 Tm (also required to give all people who use the service a copy of the service users' guide )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 111.8 Tm (which will describe a range of matters to assist the person in deciding if the home can )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 94.31 Tm (meet their needs. Our legislation sets out clear directives on the sorts of areas to be )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (included in both documents, to inform people of service provision.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (We looked at both documents given to us and found that the home's statement of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (purpose did not provide information on much of the areas which are clearly set out in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (our legislation. The home's service users' guide was approachable in style, informing )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (of significant areas such as the home's smoking policy, supports to family members, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (religious services and the named nurse and key worker systems. However it does not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (conform to our legislation in certain areas, for example,among other areas, terms and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (conditions of residence, the complaints procedure and a copy of our most recent )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (inspection report is not included in the guide. Some areas would benefit from more )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (detail, for example the guide states that residents can bring in their own items but )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (does not include a caveat about electrical items and states that the nurses are "highly )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (qualified", without specifying detail about qualifications.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (People will not be fully informed about the services offered by the home until both )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (documents have been fully revised in accordance with our legislative requirements and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (guidelines. Many homes place a copy of the information in residents rooms so that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (people can access the information at their leisure. Goatacre Manor does not do this, so )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (we asked the manager how she could demonstrate that people were able to access )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (information as required. She assured us that people were given this information )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (individually but reported that she was not able to demonstrate this.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (During the inspection, we discussed with people how they had found out about the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (home and decided about admission. Some people were too frail to recall their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (admission process, however other people were able to tell us about how they found )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (out about the home. One person reported to us that they knew about the home from )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (previous respite admissions, saying that they had been "been in and out of here for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (years". Another person reported they had decided to come into this home because )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm ("lots of people have been telling us about it".)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (A registered nurse described to us how the home supported newly admitted people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (and that that part of the key worker role was to assist the named nurse on admission )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (and to support the resident in moving in, explaining about the home, what happens )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (during the day and to introduce a new resident to other residents.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (In their AQQA, the home reported that the pre-assessment form was used to assess a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (potential resident's needs. They described it as "comprehensive and needs led". We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (considered a person who had been newly admitted in detail, reviewing their records, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (looking at their room and meeting briefly with them. We observed that the person had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (had a brief pre-admission assessment completed, which included information on such )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 511.26 w 34.6 555.78 m 562.54 555.78 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 489.89 w 33.47 543.96 m 563.66 543.96 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 296.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 296.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 297.89 m 565.87 297.89 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (areas as their medical condition, manual handling needs and risk of tissue damage. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (However much of the pre-admission assessment was brief and would have benefited )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (from much more information. For example, it was noted that this person used a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (specific appliance, but there was no information in the person's assessment about )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (what assistance they needed with the appliance, how it was to be cleaned and by )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (whom. The person also had a medical condition which can be complex to manage, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (however there was no information in the assessment as to whether they could )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (manage this medical condition, if they needed full supports, any history of how stable )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (or unstable this medical condition had been in the past or any indicators of how long )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (they had experienced this condition. The person's pre-admission assessment also did )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (not give any indication of their past life or interests.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (It is appreciated that, for a range of reasons, it is not always possible to obtain full )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (detailed information on a person's needs prior to admission and in such cases, staff )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (expand and develop outline information as soon after the person's admission as )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (possible. This had not happened for this resident. By five weeks after their admission, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (there was still no assessment or care plan relating to this person's appliance and no )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (evidence in the person's daily record that the person's appliance was being cared for. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (This was surprising as the person's daily record noted that the person's relative had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (asked about management of the person's appliance soon after their admission. When )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (we visited the person's room they had a topical application with their name on it, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (prescribed prior to their admission. This application was also noted in the person's )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (transfer letter to the home. We observed notes in this person's daily record relating to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (a sore area, but by five weeks after this person's admission, there was still no )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (assessment or care plan about use of the topical application or any sore area. This is )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (of concern, as elsewhere in this person's records it was noted that there was some )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (query that the person might have an infection, although the site of the infection was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (not documented.)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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Health and personal care )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 172.25 w 32.32 627.38 m 562.53 627.38 l S 0.001 w 0.95294 0.95294 0.95294 RG 102 w 31.2 663.63 m 563.65 663.63 l S 0.001 w 1 1 1 RG 68 w 31.2 576.38 m 563.65 576.38 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 611.5 m 565.85 611.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 611.5 m 565.85 611.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 541.25 m 565.85 541.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 540.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 540.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 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 35.5 685.57 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 35.5 668.57 Tm (medicine, they manage it themselves if they can. If they cannot manage their )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.57 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 35.5 634.57 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 35.5 617.57 Tm (dignity.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 598.32 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 35.5 581.32 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 35.5 564.32 Tm (reassured that their death will be handled with sensitivity, dignity and respect, and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 547.32 Tm (take account of their spiritual and cultural wishes. )Tj ET /F1 12 Tf BT 1 0 0 1 28.35 523 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 501 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 501 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 478.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 159.34 w 34.6 394.5 m 562.54 394.5 l S 0.001 w 1 1 1 RG 22.5 w 32.35 465.17 m 564.79 465.17 l S 0.001 w 136.85 w 33.47 383.25 m 563.66 383.25 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 452.8 m 565.87 452.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 453.88 m 32.35 312.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 453.88 m 564.79 312.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 452.8 m 564.79 452.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 313.7 m 565.87 313.7 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 461.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 437.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 437.12 Tm (poor)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 290.57 437.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 419.62 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 36.62 392.75 Tm (Residents are at risk of not having their needs met, as the home does not have clear )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 375.25 Tm (systems for ensuring that assessments and care plans, which comply with local and )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 357.76 Tm (national research-based guidelines are in place. Systems for management of )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 340.26 Tm (medicines needs improvement, to ensure people's safety. Peoples' privacy and dignity )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 322.77 Tm (is not always respected by procedures in the home.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 298.02 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 205.81 w 34.6 184.93 m 562.54 184.93 l S 0.001 w 1 1 1 RG 22.5 w 32.35 278.84 m 564.79 278.84 l S 0.001 w 184.44 w 33.47 173.12 m 563.66 173.12 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 266.46 m 565.87 266.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 267.54 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 267.54 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 266.46 m 564.79 266.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 275.52 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 250.78 Tm (During the inspection, we met with a range of residents and some of their relatives )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 233.28 Tm (and discussed with them how the home met peoples' nursing and care needs. One )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 215.79 Tm (resident's relative informed us that they were "very impressed and grateful for the )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 198.29 Tm (medical care that XX is receiving and also for the TLC and special attention XX has )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 180.79 Tm (from the nursing staff and the carers". Another relative described the care as )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 163.3 Tm ("exceptionally high". A person informed us "oh yes, they would get the doctors in if I )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 145.8 Tm (were poorly". A resident said how much they had enjoyed their hair wash and bath )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 128.31 Tm (that morning. Another resident commented on how the home had ensured that they )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 110.81 Tm (had had their eyes tested.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 93.31 Tm ()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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (A registered nurse informed us that they supported residents by having a named )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (nurse and key worker system and showed us the record of allocation which detailed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (which members of staff linked to which resident. A carer informed us that they found )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (out about residents' needs at handover and that if they were not sure about )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (something, "you can always ask the nurses". Another care assistant reported that the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (registered nurses filled in the care plans and kept them up-to-date and that care plans )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (were "always accessible". During the inspection, we observed a handover and noted )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (that all staff on the afternoon and evening shift were involved. The registered nurse )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (handing over the shift reported on different residents' current and changing )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (conditions.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (We observed that all carers consistently knocked on residents' doors and awaited a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (reply before going into the resident's room. All personal care was performed behind )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (closed doors. We met with one resident who had very little ability to converse and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (observed that they had been nicely turned out, including clean spectacles. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (observed a carer gently waking a residents up, giving them time to awaken, checking )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (if they wanted the toilet and getting their permission to take them there. We were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (concerned however, as detailed in Environment below, that some residents had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (stained commodes, one communal bath which had been used was not in a clean state )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (on both days of the inspection, a bathroom had a hairbrush in it which gave )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (appearance of being communally used and that certain items of clothing were being )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (used communally. Such practice does not up-hold residents' dignity.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (In their AQAA, the home reported on their "detailed care plans, with the resident at )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (the centre of the care plan", that "the care plans are reviewed when the resident's )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (care needs change and otherwise on a regular basis" and that "all areas of risk are )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (assessed and documented in the resident's file and reviewed on a regular basis or )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (when changes occur". They reported that currently they were commencing the use of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (a nutritional risk assessment tool, to identify people who may be at risk of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (malnutrition.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (During the inspection we met with several residents and reviewed some peoples' )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (documentation in detail. We observed that the home has systems for assessing the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (needs of resident, identifying risk and drawing up care plans to direct staff on how a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (person's needs are to be met and/or risk reduced. Some of the documentation was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (detailed and provided clear directions on how individuals' nursing and care needs were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (to be met. For example, one person's personal care plan was very person-centred and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (documented what personal care they were able to perform for themselves and what )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (areas they needed assistance with. Residents' records provided evidence of regular )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (contact with their GPs and also other healthcare professionals such as the speech and )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (language therapist, tissue viability nurse and dietitian.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (We observed that residents are assessed for risk, including areas such as manual )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (handling and risk of pressure ulceration. None of the people we reviewed had yet had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (an assessment for nutritional risk. Many of the assessments reviewed needed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (attention. For example one person's risk of pressure damage had not been totaled or )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (signed by the person completing the assessment, another person's manual handling )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (assessment had not been reviewed when they started spending much of their time in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (bed. Four of the people clearly had issues relating to dietary risk but they had not had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (an evaluation of this risk completed. None of the residents had had an assessment for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (risk of falls, although the accident book indicated that several residents would benefit )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (from such an assessment. Although several residents clearly experienced needs )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (relating to continence, we did not observe any continence assessments in the records )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (we reviewed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (Where a resident had a need or risk, there was a failure to develop care plans to direct )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (staff on how peoples' needs were to be met. Four of the people met with had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (assessments which indicated that they were at very high risk of pressure ulceration. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (None of them had care plans to direct staff on how risk was to be reduced. This is of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (concern, as the home's AQAA indicated that five people had sustained pressure )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (ulceration in the home. Two of the people we considered in detail had had pressure )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (ulcers for an extended period of time. The pressure ulcers were all reported to be of a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (minor nature. Such a high number of pressure ulcers developing in a home is an )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (unusual observation in a care home with nursing. It is understood that on occasion a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (person may be admitted with previously acquired pressure ulceration but generally, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (apart from a very few occasions, if the correct procedures are followed, people usually )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (do not develop pressure ulcers in the home or if they do, they are swiftly healed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (There is a large body of research-based evidence relating to pressure ulceration. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (Pressure ulcers, once developed may take some time to heal, are painful and present )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (a risk of infection, so the emphasis must always be on their prevention. The National )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (Institute for Health and Clinical Excellence \(NICE\) guidelines, the European Pressure )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (Ulcer Advisory Panel and local guidelines all state where a person is assessed as being )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (at risk of pressure ulcers, that as well as providing pressure relieving aids, in order to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (prevent risk of pressure ulcers, people at risk also need to have their positions )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (changed at least four hourly and for those people at higher risk, they need their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (positions changing two hourly. The guidelines also state that if a person has pressure )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (ulceration, that time sitting out of bed be limited to two hours.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (The home are not complying with these guidelines. For example one person who was )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (assessed as being at very high risk of pressure ulceration had a mattress which was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (consistent with this risk on their bed, but throughout the inspection, they were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (observed sitting in the sitting room on a cushion which was consistent with a medium )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (degree of risk. Only one of the four residents who were assessed as being at high risk )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (of pressure ulceration had a turn chart to enable staff to ensure that the person had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (their position changed at regular intervals. On 1/5/09, this person had a turn chart in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (their room which was dated 9/3/09 with a second date in margin of the record for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (28/4/09. Only five records had been made in all on this chart. By 12:15 this chart had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (been removed from the resident's room. We asked a registered nurse about turn )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (charts, they were not clear about where they were kept and reported that they might )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (be kept in the office. We observed another person who was assessed as being at high )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (risk of pressure ulceration who did have directives that they were to have their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (position changed three hourly and noted that they remained on their back, with no )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (position changes, throughout the whole inspection.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (Where a resident had sustained pressure ulceration, whilst this was documented in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (their records, no documentation had been made about the grade of the pressure ulcer. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (We asked a registered nurse about the grade of one resident's pressure ulcer when we )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (were with them in the resident's room, but they were not sure of the person's grade of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (ulcer. We also observed that the home did not routinely photograph wounds, as is )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (general practice to assist in the wound assessment process. A person who had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (sustained pressure ulceration had a full assessment and monitoring system for their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (wounds, these showed that the wounds were stable but not healing. We noted that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (this person was sitting out of bed all day, rather than being limited to only two hours )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (up, as advised in guidelines. There was no documentation in their records to state why )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (this was.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (The high levels of pressure ulceration in this home are of concern and the home needs )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (to urgently review practice and documentation systems to ensure that residents are )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (safeguarded from risks of pressure ulceration)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (The home also needs to improve its approach to frail people who are not able to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (support themselves. One person was being fed via an artificial feeding tube and was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (also taking in some diet by mouth as well. This person had full records about their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (artificial feeding system in their room. Their daily record showed some evidence that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (they refused meals at times and ate well on other days. This person had limited )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (communication abilities and was not able to feed themselves. They did not have a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (monitoring record of the food they were able to eat. In order to be able to assess )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (factors which supported this resident in taking in their diet and aid evaluation of care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (plans, a record of the person's dietary intake by mouth needs to be in place. Another )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (very frail person was cared for in bed all or most of the time, they were not able to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (give themselves drinks. However they did not have a fluid chart so that an assessment )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (could be made of their fluid intake, to assess if they were at risk of dehydration. One )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (person who did have a fluid chart in place did not have it totaled every 24 hours.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (The home uses a standard format for care plans. These state the care need and then )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (list a standard set of interventions needed to be performed. Whilst it is appreciated )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (that such an approach to care planning can assist in ensuring that all areas are )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (included, it also meant that staff can become over-reliant on standard approaches to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (care and that there will be a lack of individualisation in documentation of care needs. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (For example, several of the residents were prescribed topical application, some people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (had mention made of these applications in their care plans but others did not. Some )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (peoples' daily records made reference to the use of topical applications which were not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (included in their care plans. Other peoples' care plans made references to "suitable" )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (topical applications, without stating what they were. One person's care plan evaluation )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (started that they were now using a particular continence aid, but did not include )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (details of the size or type of continence aid or how often it was to be changed and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (treatments for the person's skin underneath the aid. None of the standard care plans )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (relating to continence pads stated the type of pad to be used for the resident. None of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (the care plans relating to urinary catheters stated the clinical reason for their use. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (Where a person was being fed artificially via a tube, there were no care plans to state )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (about how often the site for the tube was to be reviewed and how it was to be cared )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (for.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (Some of the residents were diabetics. Care plans relating to diabetes need )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (improvement. Two of the care plans stated that the aim of care was to keep the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (person's blood sugar levels within "normal" levels, without any description of what )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (normal was or what actions should be taken by staff if the resident was outside these )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (levels. Both of these people's records showed that they had had an instability in their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (diabetic condition. One persons' care plan relating to their diabetes had not been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (reviewed for several months before the inspection, although it was clear that they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (continued to be unstable in their diabetic condition. We also observed in their daily )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (record that they had had at least three recent episodes of hypoglycemia but there was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (no evidence of what staff had done to address the observation. Low blood sugar levels )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (have the potential to make a person feel unwell and can lead to a medical emergency, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (therefore they must always be effectively managed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (As well as a diabetic care plan not being evaluated we observed that one person's )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (manual handling care plan had not been reviewed when their condition changed. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (Another person had a care plan in relation to their additional mental health care needs )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (but this had not been evaluated when their condition changed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (In their AQAA, the home reported that they continue to "ensure that medication is )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (administered in accordance with policies and procedures and best practice. Regular )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (audits are conducted with the registered manager being alerted of any deficits". )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (During the inspection we observed medicines rounds, inspected storage systems for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (drugs and reviewed records relating to medicines. We observed that the home has a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (system for auditing practice in relation to medicines administration, storage and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (record-keeping.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (We observed during medicines rounds that the registered nurse carefully reviewed the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (medicines administration record, took the medicine to the resident and stayed with )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (the resident to ensure that the medicine had been taken, prior to signing the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (medicines record. We observed that while the registered nurse was with the resident )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (that they left the trolley open, this included when they were on the other side of the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (large sitting room. Throughout this period, the trolley was open and unsupervised. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (This is not good practice. After completing the medicines round, the medicines trolleys )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (were returned to purpose-built cupboards, so that the trolley did not intrude on the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (domestic atmosphere of the home. The trolley was not secured to the wall in the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (cupboard and the doors to the cupboard were not lockable. This is required to ensure )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (the safety to people. Additionally on one occasion, we found that the medicines trolley )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (had been left unlocked in the unlocked cupboard.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (We reviewed medicines administration records and were concerned to observe that a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (total of 23 records had not been completed. This included one record for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (administration of insulin. This is of concern. Unless medicines records are completed, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (it is not possible of provide evidence that a resident has been given their prescribed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (drugs. In front to the medicines administration folders, there is a policy stating that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (where medicines instructions need to be written or changed by hand, that this should )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (be signed and counter signed. A review of records showed that this had not been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (complied with in all cases. Where people are prescribed Digoxin, which can affect a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (person's pulse rate, it is accepted practice that the pulse rate should be monitored )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (before the drug is given. This was not taking place every day for all people prescribed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (the drug. Where a person is prescribed a variable dose of a drug, the actual amount )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (given was not always documented. During the inspection, we identified one person )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (who was prescribed a drug to be given three times a day who was on some days being )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (given it two times a day. There were no records to state why this was and a registered )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (nurse we spoke with was not sure of the reasons either. This had been addressed by )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (the second day of the inspection, however it should not have been happening. Where )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (medicines were being given by injection on a regular basis, on the first day of the )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (inspection, there were no monitoring systems to ensure that the site of the injection )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (was rotated, to prevent tissue damage. This had been addressed by the second day of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (the inspection, but this need should have been identified in the home's audit process.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (The home has a clinical room for storage of medicines. The manager reported that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (they were planning to go over to a new contract for medicines and that as part of this, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (the clinical room would be fully up-graded. We observed systems for storage of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (Controlled Drugs and found that they were safe. However we observed that a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (medication error had occurred in relation to a Controlled Drug which had happened )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (two days before the first day of the inspection, which had not been noted until the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (inspection day. When the home did notify us of this error, their form stated that the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (person's GP had not been informed, with no indication of why this was. Both these )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (matters are of concern.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (We observed systems for storage of medicines which needed to be kept in a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (refrigerator. We observed on the first day of the inspection that the fridge door was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (open when we came into the clinical room and that it would not close, unless it was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (locked. We looked at the temperature record for the fridge and observed that it had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (been over the required temperature since 23/3/09. By the second day of the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (inspection, the fridge had been defrosted and temperature levels returned to normal. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (It is of concern that this had not been identified before the inspection, as it could have )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (affected the efficacy of some drugs.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (We observed that many of the residents had been prescribed topical applications but )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (there was no system to document if they had had these creams and lotions applied, as )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (prescribed. In addition, in the en-suite of on double room shared by two male )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (residents, there was a used topical application for a female person. In a communal )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (toilet there was also a used prescribed cream for a named person left on the toilet )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (cistern. Prescribed medicines belong to the person and must only be used for the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (person for whom they have been prescribed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (At the last inspection, it was required that there must be clear and objective )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (guidelines for the use of all "as required" medications, to promote their consistent use. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (During the inspection we observed that two of the people we considered in detail were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (prescribed drugs on an "as required" basis. We did not observe any care plan or )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (protocol about this in their records. We discussed this un-met requirement with the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (manager at the end of the inspection, who reported that she had instructed staff to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (include directives for "as required" medication on the medicines administration record. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (This inspection did not evidence that this had taken place.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm ()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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 126.35 w 34.6 748.23 m 562.54 748.23 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 104.98 w 33.47 736.42 m 563.66 736.42 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 681.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 681.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 682.81 m 565.87 682.81 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (This review of systems for management of medicines indicates that the home needs to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (improve its performance in audit of systems and practice. Matters have been identified )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (at this inspection which should have already been identified by the home and actions )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (taken and additionally, a requirement from the previous inspection has not been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (addressed. Failure to ensure safe systems for management of medicines could put )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (residents at risk.)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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Daily life and social activities )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 138.25 w 32.32 644.38 m 562.53 644.38 l S 0.001 w 0.95294 0.95294 0.95294 RG 119 w 31.2 655.13 m 563.65 655.13 l S 0.001 w 1 1 1 RG 17 w 31.2 584.88 m 563.65 584.88 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 594.5 m 565.85 594.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 594.5 m 565.85 594.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 575.25 m 565.85 575.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 574.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 574.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 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 35.5 685.57 Tm (race, culture, religion, age, disability, gender and sexual orientation. They are part of )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 668.57 Tm (their local community. The care home supports people to follow personal interests and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 651.57 Tm (activities. People are able to keep in touch with family, friends and representatives. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.57 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 35.5 617.57 Tm (opportunity to make the most of their abilities. People have nutritious and attractive )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 600.57 Tm (meals and snacks, at a time and place to suit them.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 581.32 Tm (There are no additional outcomes.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 557 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 535 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 535 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 512.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 141.85 w 34.6 437.25 m 562.54 437.25 l S 0.001 w 1 1 1 RG 22.5 w 32.35 499.17 m 564.79 499.17 l S 0.001 w 119.35 w 33.47 426 m 563.66 426 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 486.8 m 565.87 486.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 487.88 m 32.35 364.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 487.88 m 564.79 364.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 486.8 m 564.79 486.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 365.2 m 565.87 365.2 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 495.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 471.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 471.12 Tm (adequate)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 319.4 471.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 453.62 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 36.62 426.75 Tm (People will be supported in exercising choice in some areas, particularly mealtimes. )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 409.25 Tm (However a lack of individualised planning to meet peoples' social care needs, means )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 391.76 Tm (that peoples' individual choices will not be fully considered.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 374.26 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 349.52 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 257.3 w 34.6 210.68 m 562.54 210.68 l S 0.001 w 1 1 1 RG 22.5 w 32.35 330.33 m 564.79 330.33 l S 0.001 w 235.93 w 33.47 198.87 m 563.66 198.87 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 317.96 m 565.87 317.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 319.04 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 319.04 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 317.96 m 564.79 317.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 327.02 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 302.27 Tm (In their AQAA the home stated that the "duty rosters show that staffing levels are )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 284.78 Tm (sufficient to provide a high standard of care and time to spend with the residents", )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 267.28 Tm (that "menu choice is completed daily for the following day with special requirements )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 249.79 Tm (and requests complied with as far as possible" and "visitors are welcomed to the home )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 232.29 Tm (at any time convenient to the resident and offered all the normal niceties of visiting, )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 214.79 Tm (such as being offered a drink or joining a resident for a meal".)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 197.3 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 179.8 Tm (The home reported in their AQAA that whilst they do not employ an activities person, )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 162.31 Tm (that carers are expected to support residents in activities as part of their normal role. )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 144.81 Tm (They also report that a variety of entertainers come to the home, that trips out are )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 127.31 Tm (organised and that a "pat" dog visits the home regularly.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 109.82 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 92.32 Tm (During the inspection, we observed staff were available and chatting with residents in )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (the sitting rooms. One resident reported "I write a lot and do crossword puzzles", )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (another "we have an art teacher who comes in Monday afternoons" and another "we )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (have quizzes which are good because they keeps your mind working". Other residents )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (commented differently. One reported that they spent their time watching the "big )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (screen" meaning the television, another "there's no physiotherapy here" and another )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm ("can't walk far, like someone to talk to".)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (The home does not have an activities programme as such and it appeared talking with )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (staff that when carers provided activities, this was not done on a planned basis. For )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (example, the first day of the inspection took place on May Day, in many homes, as )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (this is a calendar event of interest, activities would be themed round such a day, to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (support orientating residents with memory loss in remembering the time and season )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (of the year. It is appreciated that with frail residents, activities need to be provided in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (a flexible basis but the home would benefit from a structure to activities, particularly )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (to support residents who are mentally frail. A review of training records did not show )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (that carers had been trained in activities provision.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (At the last inspection, it was recommended that the content of the activities section of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (care plans should be developed, to support the provision of opportunities likely to be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (of benefit to each individual person. In their AQAA, the home stated that "care plans )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (have been further developed to reflect every aspect of a resident's needs". We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (reviewed a range of care plans and observed that whilst some residents had detailed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (records about their past lives, others had no details at all. Without information on how )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (people used to live their lives, it is difficult to plan to meet residents' individual social )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (needs. The homes' social care plans are a standard document with set phrases, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (although there is space on the forms to make additions if needed. None of the care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (plans we looked at showed any person-centered information relating to how their own )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (social care needs were to be met had been added to their care plan. Care plans were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (reviewed, but all the ones we reviewed stated "no changes", however as no )Tj ET /F2 12 Tf BT 1 0 0 1 497.36 289.21 Tm (person-)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (centered)Tj ET /F2 12 Tf BT 1 0 0 1 86.95 271.71 Tm ( information had been included, it was not possible to assess how the person )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (had been assessed as having no changes. Records relating to activities did not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (evaluate their benefit to residents, for example peoples' comments, facial expressions, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (body language and actual participation for frailer people.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (In their AQAA, the home reported on their close links with relatives and this was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (supported by comments made by relatives. One relative reported "they keep in touch )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (if XX is not well, they let me know of any day in bed" and another "when it's been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (necessary they've informed me" - about changes in the resident's condition. Another )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (relative commented "I can telephone or visit them knowing that I will be met with a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (sympathetic ear and a willingness to help." As noted above, care plans relating to )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (social care needs are a standard format and do not include factors, such as family )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (involvement. During the inspection, we met with two relatives who were able to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (describe in detail their involvement with their relative, none of this was documented in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (the peoples' records. If a resident fell, there was clear information that relatives were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (informed of the accident and the resident's condition. However the home has notified )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (us of one medication error but documented in their report that the relative was not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (informed, without detailing the reasons why, and when we discussed the high number )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (of residents with pressure ulceration, the manager reported that the home did not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (inform relatives of such matters. This is of concern, as both issues could present risk )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (to the resident and their relative or advocate needs to be made aware of such )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (matters.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (Goatacre Manor is situated in the centre of a village and as such it can have close links )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (with the local community. One care assistant was observed during the afternoon )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (bringing their children in to meet with residents, which all parties clearly enjoyed. In )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (their AQAA, the home did not specifically comment on any links with local churches. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (Practice of religion is noted on the standard care plan format, using a set phrase, with )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (no detail of the individual's specific needs. It was noted for one individual that this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (standard phrase conflicted with what was documented on their admission assessment, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (but this had not been expanded further in the person's care plan. Practice of religion )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (\(or not\) is a significant area to some people, this needs to be actively considered, so )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (as to ensure that people's needs are being met.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (We asked people about choice. One person reported that they "can get up and go to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (bed when I like, I should hate to be told of bed times" and another "can decide when I )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (get up and go to bed". During the inspection, when a television programme had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (finished, we observed a care assistant discussing with residents what they wanted to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (watch next. At 9:45am we observed that most of the residents were up and dressed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (and sitting in one of the two sitting rooms, apart from a few very frail people who )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (remained all or most of their time in bed. This is an unusual observation, as in most )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (care homes there tend always to be some people who prefer to get up much later in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (the morning. We reviewed care plans relating to this area, however as the care plans )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (were generic, there was only a standard phrase about exercising choice, with no )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (further information on matters, for example of when people preferred to get up and go )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (to bed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (Many residents commented on the meals. One person reported "we get a jolly good )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (lunch", another "the food's not bad, you get a choice and its hot", another "you get )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (enough, you don't go hungry" and another "the puddings are great, she makes )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (wonderful steamed puddings and baked puddings". A relative commented "the kitchen )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 493.76 w 34.6 564.52 m 562.54 564.52 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 472.39 w 33.47 552.71 m 563.66 552.71 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 314.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 314.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 315.39 m 565.87 315.39 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (staff makes a difficult task look relatively easy." People also commented on choice. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (One person reported "If you don't like the second choice, the cook does her best to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (give you what you prefer" and another "ask for egg on toast and you always get it". )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (One person did comment "we get too many sandwiches".)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (We met with the chef, who showed a detailed, individual knowledge of different )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (residents and what they liked to eat. They reported that they cooked all meals from )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (raw ingredients, including soups, sauces, chicken nuggets and fish cakes. They )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (reported that if someone did not like either of the choices on the menu, they were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (happy to provide a different alternative and was able to provide several examples of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (when they had done this. They reported that they offered a choice of meals to people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (on a soft or liquidised diet, stating that it was important for frail people to be offered )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (what they wanted to eat. This is regarded as good practice, as in other homes, when )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (someone cannot eat a normal meal, they are not always offered choice.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (We observed a mealtime. There was a relaxed atmosphere at the meal time, with no )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (evidence of rush, although many of the residents needed support to eat their meals. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (We observed that the meals were nicely presented. They were obviously hot and the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (carers needed cloths to hold the plates. Carers supported residents in making the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (meals a social occasion. We observed carers encouraging people in discussing their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (preference for chips over mashed potato. We observed a registered nurse supporting )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (a resident in eating finger foods, so that they could continue to give themselves their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (meal independantly. We also observed a care assistant supporting a resident who was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (confused in continuing to feed themselves, rather than taking over from the resident. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (Where a resident did need to be fed by a member of staff, they sat with them, trying )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (to engage the person in conversation and ensuring that they were swallowing their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (meal safely.)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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Complaints and protection )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 87.25 w 32.32 669.88 m 562.53 669.88 l S 0.001 w 0.95294 0.95294 0.95294 RG 68 w 31.2 680.63 m 563.65 680.63 l S 0.001 w 1 1 1 RG 17 w 31.2 635.88 m 563.65 635.88 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 645.5 m 565.85 645.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 645.5 m 565.85 645.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 626.25 m 565.85 626.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 625.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 625.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 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 35.5 685.57 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 35.5 668.57 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 35.5 651.57 Tm (allegations.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 632.32 Tm (Peoples legal rights are protected, including being able to vote in elections.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 608 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 586 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 586 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 563.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 141.85 w 34.6 488.25 m 562.54 488.25 l S 0.001 w 1 1 1 RG 22.5 w 32.35 550.17 m 564.79 550.17 l S 0.001 w 119.35 w 33.47 477 m 563.66 477 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 537.8 m 565.87 537.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 538.88 m 32.35 415.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 538.88 m 564.79 415.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 537.8 m 564.79 537.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 416.2 m 565.87 416.2 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 546.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 522.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 522.12 Tm (poor)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 290.57 522.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 504.62 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 36.62 477.75 Tm (The home cannot provide full evidence that people are aware of how to raise matters )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 460.25 Tm (of concern to them and that they respond when issues are raised. Staff need to be )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 442.76 Tm (trained in protection of vulnerable adults and key areas need improvement to ensure )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 425.26 Tm (that people are safeguarded.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 400.52 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 308.3 w 34.6 236.18 m 562.54 236.18 l S 0.001 w 1 1 1 RG 22.5 w 32.35 381.33 m 564.79 381.33 l S 0.001 w 286.93 w 33.47 224.37 m 563.66 224.37 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 368.96 m 565.87 368.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 370.04 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 370.04 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 368.96 m 564.79 368.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 378.02 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 353.27 Tm (The home's complaints policy is displayed in the front entrance hall. As noted in )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 335.78 Tm (Choice of Home above, the home's service users' guide does not include the homes' )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 318.28 Tm (complaints policy, so some people may not be fully informed of the home's procedure.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 300.79 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 283.29 Tm (We talked to a range of people during the inspection about how they raised areas of )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 265.79 Tm (concern and received a varied response. One person reported "talk to the lady in )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 248.3 Tm (charge, Oh yes, she listens very kindly", another "I'd get the under manager I )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 230.8 Tm (suppose", another "if I'm not happy, I'd talk to one of the nurses" and another "I'd )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 213.31 Tm (talk to the staff, I'm sure they'd listen". Other people were not so sure. One person )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 195.81 Tm (reported "If I was worried, I'd talk to ..[pause].. the first one who came, they would )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 178.31 Tm (listen to me", another person reported "if I'm not happy about something, there's )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 160.82 Tm (nobody really to talk to", another "I don't think I'd know who to talk to if I wasn't )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 143.32 Tm (happy with something here" and another "I've not seen the manager". These )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 125.83 Tm (responses indicate that there may be a need to support people in knowing how to )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 108.33 Tm (raise issues of concern to them.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 90.83 Tm ()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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (In their AQAA, the home reported "complaints are recorded and followed up )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (meticulously. Concerns are documented separately with action and outcome recorded. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (Residents and those close to them are encouraged to bring all concerns to the nurses )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (or manager to ensure that something is done about them immediately". We asked to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (look at both these documents reported on in the home's AQAA. Discussions with the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (manager indicated that the home had had no complaints in the past twelve months )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (and so the complaints book had not been used. However discussions with the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (administrator indicated that they had started dealing with a matter and had then )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (passed it on to the manager for further action. On discussion, the manager reported )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (that they knew about this matter and that it was on her computer file. We met with a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (resident who raised a particular area of concern which they reported they had raised )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (several times. Discussions with a range of staff indicated that they were aware of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (these concerns, however contrary to the statement in the home's AQAA, no record )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (had been made of these concerns. During the inspection, two residents also reported )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (on two other matters of concerns to them, they were of the impression that they had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (mentioned these matters to staff, but there appeared to have been no records made )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (of these matters.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (The home needs to improve and develop its approach towards complaints and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (concerns. Many managers regard receipt and review of complaints and concerns as a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (key area in their quality audit, to show them how the service affects different people.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (In their AQAA, the home stated that "each employee is trained in the protection of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (vulnerable adults". During the inspection, we discussed training in abuse awareness )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (with the training manager, they reported that this is done using a DVD, followed by )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (discussions and a short test. We discussed training with a range of staff. The chef )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (reported that they and all their staff had attended training in the protection of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (vulnerable adults. We discussed the matter with the person performing laundry who )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (did not think that they had received such training. We looked at staff training records )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (and of the 25 we looked at only four showed that the member of staff had been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (trained in safeguarding adults during the past year. We discussed awareness of this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (key area with people and while some of them, when given scenarios, were fully aware )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (of actions to take, others, including a registered nurse, who may be in charge of the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (home, was not aware of appropriate actions to take to safeguard vulnerable people in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (accordance with local procedures.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (As noted in Health and Personal Care above, the home has a higher than would be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (anticipated number of people who have sustained pressure damage in the home. This )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (is of concern as the home is not following research-based evidence in relation to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (prevention of pressure damager and may indicated that people are not being )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 178.84 w 34.6 721.99 m 562.54 721.99 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 157.46 w 33.47 710.18 m 563.66 710.18 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 629.24 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 629.24 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 630.32 m 565.87 630.32 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (safeguarded from harm. The section on Staffing below indicates that the home )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (continues not to ensure that it uses safe practice in the recruitment of staff, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (particularly in providing evidence that staff work fully supervised after their protection )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (of vulnerable adults \(pova\) check has been returned and before their criminal records )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (board \(CRB\) check has been returned. This also has the potential to put vulnerable )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (people at risk. As shown in Management and Administration below, the home are not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (using safe practice in the use of bed safety rails, which could put residents at risk. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (Unsafe practice in the use of bed safely rails is a well-researched area and has been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (associated with significant risk to residents.)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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Environment )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 104.25 w 32.32 661.38 m 562.53 661.38 l S 0.001 w 0.95294 0.95294 0.95294 RG 34 w 31.2 697.63 m 563.65 697.63 l S 0.001 w 1 1 1 RG 68 w 31.2 644.38 m 563.65 644.38 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 679.5 m 565.85 679.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 679.5 m 565.85 679.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 609.25 m 565.85 609.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 608.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 608.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 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 35.5 685.57 Tm (hygienic. )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 666.32 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 35.5 649.32 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 35.5 632.32 Tm (specialist equipment that encourages and promotes their independence. Their room )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 615.32 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 28.35 591 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 569 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 569 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 546.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 141.85 w 34.6 471.25 m 562.54 471.25 l S 0.001 w 1 1 1 RG 22.5 w 32.35 533.17 m 564.79 533.17 l S 0.001 w 119.35 w 33.47 460 m 563.66 460 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 520.8 m 565.87 520.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 521.88 m 32.35 398.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 521.88 m 564.79 398.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 520.8 m 564.79 520.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 399.2 m 565.87 399.2 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 529.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 505.12 Tm (adequate)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 319.4 505.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 487.62 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 36.62 460.75 Tm (The home environment supports residents, with good supplies of equipment to meet )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 443.25 Tm (the needs of people with a disability. However facilities and practice in prevention of )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 425.76 Tm (spread of infection does not support appropriate practice or the privacy and dignity of )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 408.26 Tm (residents.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 383.52 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 291.3 w 34.6 227.68 m 562.54 227.68 l S 0.001 w 1 1 1 RG 22.5 w 32.35 364.33 m 564.79 364.33 l S 0.001 w 269.93 w 33.47 215.87 m 563.66 215.87 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 351.96 m 565.87 351.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 353.04 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 353.04 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 351.96 m 564.79 351.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 361.02 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 336.27 Tm (Goatacre Manor is an older building, which as been extended. Accommodation is )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 318.78 Tm (provided on one floor at the older part of the building and on two floors at the newer )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 301.28 Tm (part of the building. There is a passenger lift between the two floors. The home is in )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 283.79 Tm (the centre of the village of Goatacre and looks out over lawns at the back, with a )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 266.29 Tm (cricket field beyond and garden and courtyard areas to the front. One resident was )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 248.79 Tm (very pleased with the view from their window, reporting "look at that view" to us. A )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 231.3 Tm (relative commented "there are always lovely flowers and plants and pictures )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 213.8 Tm (throughout the home for patients and visitors to enjoy". Most of the accommodation is )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 196.31 Tm (provided in single rooms, although there are some double rooms. Screening is )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 178.81 Tm (provided in double rooms and one resident we met with reported that staff always )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 161.31 Tm (used the screens when providing personal care.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 143.82 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 126.32 Tm (There is a choice of two sitting/dining rooms in the home. Both rooms are large and )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 108.83 Tm (provide accommodation to suit people, including people with complex disability needs. )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 91.33 Tm (One person said "It's a lovely room" about the sitting room they were in and another )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm ("this certainly is a beautiful room". One person reported that they were "very lucky to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (have this sort of accommodation". Another person reported "I'm very lucky to have a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (room like this". Residents are enabled to bring in items of their own if they wish and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (some of the rooms had a highly personalised atmosphere, reflecting the person's likes )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (and preferences.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (In their AQAA, the home reported on how they continually reviewed the facilities )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (offered and were gradually up-grading rooms to provide en-suite facilities where )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (possible. They reported that since the last inspection, among other areas, they had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (made improvements to the entrance area, provided a purpose-built hairdressing area )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (and had invested in large flat-screen televisions in sitting areas. These were observed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (during the inspection.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (We reviewed equipment during the inspection and observed a wide range of hoists to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (aid manual handling. These were clearly being used. One resident reported "I'm )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (hoisted from my chair into my bed and out of bed" and another "I use a chair and I )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (use a hoist". We observed that there was an ample supply of pressure relieving )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (mattresses and cushions, including air mattresses and cushions. Air mattresses were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (appropriately used with sheets placed loosely over them, in accordance with )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (manufacturers' instructions. We observed a range of different chairs were available to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (meet the needs of people who had complex seating needs. Beds were hospital type )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (with metal frames. We observed that the home does not generally use profiling beds. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (These are recommended, to reduce the risks associated with hospital beds, as )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (profiling beds have integral bed rails which are safer, or preferably they can be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (lowered to the floor and crash mats used, to reduce risks associated with use of bed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (rails.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (The home has disabled showers and assisted baths with integral hoists. This means )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (that people who are unable to bend at the waist or the knee may find accessing such )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (baths complex. As the disability needs in this client group is likely to increase, the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (home should, consider widening its range of bathing facilities to offer a wider choice to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (people.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (We met with a cleaner and observed her in the role. One relative commented "it's so )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (lovely and clean" about the home and a resident reported "very clean, very good". The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (cleaner reported that they had a good supply of cleaning equipment and chemicals. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (We noted that difficult to reach areas such as the undersides of raised toilet seats )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (were clean.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (The home needs to review its commode chairs. Some chairs were clean, with intact )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (surfaces but others were old, some had stained and/or torn upholstery, some had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (rusty metal frames and some had stained commode buckets. Commode chairs need to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (be in a condition where they can be properly cleaned to reduce risks of cross infection )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (and support the dignity of residents.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (The home only has one sluice room with a washer disinfector. We asked a range of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (staff about a cleaning schedule for commode buckets, but there did not seem to be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (one. This may be a factor in the observation of stained commode buckets. The home )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (needs to develop a clear written cleaning schedule, to ensure that commode buckets )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (are regularly cleaned.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (We observed that the sluice room had several used commode buckets sitting on top of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (the washer disinfector, waiting to go through the machine. The room had a wash hand )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (basin, single use soap and a paper towel dispenser, but it did not have a rubbish bin. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (It also did not have any plastic aprons or disposable gloves. These are is needed, as a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (member of staff placing the used commodes in the washer disinfector would need to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (use both and be able to dispose of such aids safely, to ensure that risk of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (contamination is reduced. The fact that several commode buckets were awaiting )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (disinfecting, as well as noting several stained commode buckets as detailed above, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (indicates that practice would be further supported by provision of a second washer )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (disinfector.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (The home would benefit from modernising some other areas relating to infection )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (control. We observed that in some communal bathrooms and toilets yellow bags for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (infected items were placed in open bins, this reduces risks of hand contamination )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (when placing items in bins but will not be pleasant for anyone using the facility. In one )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (shower room, there was a bin with a yellow bag in it for clinical waste which had been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (placed in a standard bin. In order to prevent risks of hand contamination when placing )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (infected and potentially infected items in bins, foot pedal operated bins must always )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (be used for clinical waste.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (We reviewed provision of gloves and aprons and observed that there was a good )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (supply of a wide range of sizes in the store rooms. A carer reported to us that they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (carried a supply of gloves for general use in their pocket and showed us their supply. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (Sterile gloves were available in the clinical room for aseptic technique. On discussion )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (with the manager, it appeared that sterile gloves were not being used for wound )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (dressings. We have discussed this with the senior tissue viability nurse for the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (Wiltshire Primary Care Trust, who reports that sterile gloves must be used for all )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (wound dressings, to prevent risk of infection to the wound.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm ()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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (Practice in the prevention of spread of infection needs to be improved. We noted that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (a jar of topical cream had been left in a toilet, it had been opened and used. In a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (double room, a jar of opened and used cream had been left on a surface, not close to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (either person's receptacle for personal items. As noted in Health and Personal Care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (above, a cream relating to a female resident had been placed in a room shared by two )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (male residents. Many of the jars of cream did not have the resident's name on it. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (Communal use of topical creams is a major risk to cross infection, therefore all creams )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (need to be named and used only for that person. We also discussed how staff are )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (instructed to take creams out of jars, if they use a spatula to spread the cream on )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (their gloved hand or change their glove prior to putting their hand in the jar, and did )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (not receive a clear answer. When performing personal care, in order to reduce risks of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (re-infection one of the two practices must take place.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (We observed a range of used tablets of soap in all of the communal bathrooms and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (shower rooms. In one en-suite in a double room, a tablet of used soap had been left )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (on the wash hand basin, with no indication as to which person it belonged to. One )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (shower room did not have a soap dispenser in it. A shower room had a used, unnamed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (hair brush in it. Communal use of tablets of soap is a risk to cross infection and such )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (tablets must be disposed of promptly if their owner cannot be identified. As hand )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (washing is the single most important factor in the prevention of spread of infection, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (facilities for single use soap must always be available in all relevant areas. Communal )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (use of hair brushes may not constitute a major risk to cross-infection, however such )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (practice does not support residents' privacy and dignity.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (We looked at two different en-suites in double rooms. In both of these double rooms, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (there were two wash bowls in the en-suites, both were of the same colour and neither )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (was named. Both were damp. We asked staff how they made sure that each bowl was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (always used for the same resident. They informed us that after use, the bowl would be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (dried and left with the person's named container of toiletries. This was not observed to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (be the case. In one en-suite, one bowel had been left on the window-sill and the other )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (on the toilet cistern and in the other en-suite one bowel had been left inside the other, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (in the wash hand basin. This is clearly not satisfactory.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (On both days of the inspection, a communal assisted bath, which several people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (informed us was the only assisted bath used, had visible brown staining down all of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (the inside of the bath under the taps, down to the plug-hole. The use of a communal )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (bath which is not clean can put people at risk of cross infection and does not support )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (their dignity.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (As noted above, many residents needed to be moved by means of a hoist and slings. )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (Slings were reported to be used communally. Hoist slings cross over at people's legs )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (and therefore can present a risk of cross infection. If a person needs to always be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (moved in this way, in order to prevent risk of cross infection, either disposable slings )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (must be used or slings need to be named for the person and used only for them. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (Slings will also need regular laundering. We discussed this with the laundress but )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (there did not appear to be a system for the regular laundering of hoist slings. We also )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (discussed the cleaning of hoists. It was reported that night staff clean the hoists but )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (there was no written rota to support this.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (We went into the laundry and discussed the service with the laundress. The laundress )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (showed a good knowledge of her responsibilities in relation to prevention of spread of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (infection. She was able to show us that she had good supplies of gloves and aprons. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (She reported that staff use red alginate bags for infected and potentially infected )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (laundry. However she also reported that she needed at times to open these bags, as )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (people would put items in them such as cardigans, which would need a different sluice )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (wash. This is not safe practice as infected and potentially infected items can )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (contaminate other items if they are taken out of bags and re-sorted in the laundry. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (The laundress reported that all other used laundry is placed in linen bags and taken to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (the laundry, where it is re-sorted. This is not ideal practice and preferably used items )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (should be separated at source. This particularly the case as there were areas in the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (laundry, such as behind the washing machines, which were difficult to clean and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (where debris was visible. Additionally the washing machine plinths were stained with )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (debris visible. Such accumulations can provide areas where micro-organisms can live.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (The home uses net underwear for people with complex continence care needs. They )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (also have a supply of "pop" socks which are used by female residents. None of these )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (items were named and it was reported that they were generally used for all residents )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (who needed them. This does not support residents' privacy and dignity and it also may )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (present a risk of cross infection. There are several simple systems, such as small net )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (bags which can be named, which can be used to launder such items.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (The home has trolleys which have shelves for clean laundry, with a round container )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (for used linen at the end. We observed during the inspection that a bag of used )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (laundry was placed in this container. The use of such trolleys in this way can present a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (risk to cross-infection. We discussed this with the manager, who reported that it was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (not usual practice.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (During the inspection, we inspected the kitchen and it was reported that they had a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (good supply of equipment and cooking utensils. The kitchen appeared clean and well )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (managed. We did observe that the kitchen floor was stained and showing signs of age. )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 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 108.85 w 34.6 756.98 m 562.54 756.98 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 87.48 w 33.47 745.17 m 563.66 745.17 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 699.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 699.23 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 700.3 m 565.87 700.3 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (Plans should be developed for its improvement before it deteriorates further. During )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (lunch we observed that meals were plated from hot trolleys. We observed that care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (assistants handled some items of food with their bare hands from both trolleys. It is )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (not appropriate practice as it can lead to food contamination and if this needs to be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (done, utensils must be used or gloves worn.)Tj ET endstream endobj 85 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 86 0 obj <>stream 0 J 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 (36)Tj ET 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Staffing )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 104.25 w 32.32 661.38 m 562.53 661.38 l S 0.001 w 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.65 672.13 l S 0.001 w 1 1 1 RG 17 w 31.2 618.88 m 563.65 618.88 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 609.25 m 565.85 609.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 608.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 608.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 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 35.5 685.57 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 35.5 668.57 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 35.5 651.57 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 35.5 634.57 Tm (managers.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 615.32 Tm (There are no additional outcomes.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 591 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 569 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 569 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 546.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 106.85 w 34.6 488.74 m 562.54 488.74 l S 0.001 w 1 1 1 RG 22.5 w 32.35 533.17 m 564.79 533.17 l S 0.001 w 84.36 w 33.47 477.5 m 563.66 477.5 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 520.8 m 565.87 520.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 521.88 m 32.35 433.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 521.88 m 564.79 433.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 520.8 m 564.79 520.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 434.19 m 565.87 434.19 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 529.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 505.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 505.12 Tm (poor)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 290.57 505.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 487.62 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 36.62 460.75 Tm (Residents will not be supported by staff who have been safely recruited and who are )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 443.25 Tm (trained to meet their nursing and care needs. )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 418.51 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 326.3 w 34.6 245.17 m 562.54 245.17 l S 0.001 w 1 1 1 RG 22.5 w 32.35 399.32 m 564.79 399.32 l S 0.001 w 304.93 w 33.47 233.36 m 563.66 233.36 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 386.95 m 565.87 386.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 388.03 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 388.03 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 386.95 m 564.79 386.95 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 396.01 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 371.27 Tm (In the AQAA, the home described that "staffing levels are generous at all times of day )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 353.77 Tm (to facilitate providing good opportunities for either group activities or one to one )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 336.27 Tm (depending on the resident's ability and choice". During the inspection we observed )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 318.78 Tm (that staff were always readily available to residents and, as noted above in comments )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 301.28 Tm (relating to mealtimes, the meal was conduced in a relaxed, calm manner with no )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 283.79 Tm (feeling of rush. Staff reported that the home was generally well staffed and that )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 266.29 Tm (staffing levels were only an issue with un-planned sickness.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 248.79 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 231.3 Tm (We asked people about staffing levels. One relative commented "there seem to be )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 213.8 Tm (plenty of staff around", a resident commented on how they had a bell and "you can )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 196.31 Tm (always get someone" and another "press the bell and along comes somebody". )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 178.81 Tm (However other people were not so sure about staffing levels. One resident reported )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 161.31 Tm ("on occasions, they are understaffed at mealtimes and changeover", another on )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 143.82 Tm (ringing their bell "sometimes they are quick and sometimes they're not" and another )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 126.32 Tm ("you get left alone a lot and then there's masses of them". One resident commented )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 108.83 Tm (to us that they felt that the response time to the call bell was slow and that on one )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 91.33 Tm (occasion they had had to wait 40 minutes for a response. We asked the manager if )Tj ET endstream endobj 87 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 88 0 obj <>stream 0 J 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 (37)Tj ET 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (they monitored response times when the call bell was used and she reported that they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (did not. In their AQAA, the home reported that they were planning to fully up-grade )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (and modernise the call bell system.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (At the last inspection, it was required that staff records must contain evidence that all )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (required recruitment checks have been completed for all employees. In their AQAA, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (the home commented "staff commence employment only after the home has received )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (suitable references, a record of employment history and POVA clearance". During the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (inspection, we looked at five files of staff who had recently commenced employment. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (We found that one person only had one reference on file, another person had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (unexplained gaps in their employment history, which there was no evidence had been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (probed and two staff had no photographs or other proof of identity. This is of concern, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (as this matter was identified as a requirement at the previous inspection. Residents )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (may not be safeguarded if all recruitment processes, which have been set out for their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (protection, have not been complied with.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (One person had commenced work after their pova clearance had been obtained but )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (before their CRB clearance had been returned. Our legislation states that staff may )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (commence work after pova clearance has been returned, but they must work fully )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (supervised until CRB clearance is received. There was no written evidence that this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (was taking place. Staff we spoke to did report that a new member of staff was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (allocated to a mentor, however that due to the staff rotas, the person would not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (always be on duty at the same time as their mentor and they were not aware of any )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (additional supervison systems, until CRB clearance was obtained.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (When staff commence work, they are given an induction. The home has an induction )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (checklist and the training manager reported that on the new member of staff's first )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (day, they go through the check-list with them, reporting that generally this takes two )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (to three hours. The check-list is extensive, covering a range of areas. A registered )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (nurse reported on the induction, that the new member of staff was trained by the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (trainer, then allocated to a senior carer as mentor. The new member of staff would )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (observe at first, then become more hands on, as they become more confident. A new )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (member of staff would not work on own their own until assessed as able to do so. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (About four weeks after the person had commenced employment, the training manager )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (will see the new member of staff again and ask them to give a feedback, including )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (assessing their understanding of safeguarding. Three members of staff are qualified )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (manual handling trainers and they will induct the new person in this area. Two to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (three hours may not be sufficient to cover all areas on induction, however too much )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (information at one time may not be beneficial to learning. Many homes break down )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (their induction programme, so that areas are covered in a structured manner, over )Tj ET endstream endobj 89 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 90 0 obj <>stream 0 J 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 (38)Tj ET 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (several days and weeks, as this is more supportive to a new member of staff. Where )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (this happens, such procedures are fully documented and a copy retained on the new )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (member of staff's file.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (In their AQAA, the home reported that they were supportive of National Vocational )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (Qualifications \(NVQs\) and that 90% of care staff were trained to NVQ II or above. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (chef reported that all their staff had undertaken food hygiene training. The home )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (employs a training manager who works six hours a day, four days a week. This is not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (their only role, the person also acts as key worker for a number of allocated residents )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (and on the second site visit was spending the morning with the nurse assessor from )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (the primary care trust, supporting the person in their assessments of residents. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (training manager was a member of staff and had taken on this role in the past few )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (years, they are not a qualified trainer and had not received training in this role. They )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (reported that the home uses a mix of in-house and external training methods.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (In order to assess who needed training in which areas, the training manager reported )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (that they went through staff training records. The home do not maintain a matrix of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (staff training to facilitate assessment of which member of staff is due mandatory )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (training. We reviewed 25 staff training records and this showed that out of 25 )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (members of staff, 20 had undertaken infection control training, 15 manual handling )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (and one first aid, during the past year.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (We discussed with the training manager that 10 members of staff had not been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (trained in manual handling, which needs to take place on an annual basis. The training )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (manager reported that some records might not be up-to-date, as the manual handling )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (trainers may not have up-dated the most recent training given and also that some )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (staff were not keen to attend mandatory training. We were particularly concerned by )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (this matter as we had observed some inappropriate manual handling practice by staff )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (- see Management and Administration below, which indicated that some staff were not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (aware of their responsibilities for safe manual handing.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (The training manager reported that on occasion some staff showed reluctance to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (attend training sessions. We discussed with the training manager that we were aware )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (that this could take place in care providers and that other providers approached the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (issue by having clear management systems to ensure that staff were trained. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (Management systems have included regular review of records and letters from the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (provider outlining the responsibilities of both sides. Discussions with the training )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (manager and the home manager did not indicate that there were clear processes in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (this area.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm ()Tj ET endstream endobj 91 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 92 0 obj <>stream 0 J 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 (39)Tj ET 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 458.77 w 34.6 582.02 m 562.54 582.02 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 437.4 w 33.47 570.21 m 563.66 570.21 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 349.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 349.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 350.38 m 565.87 350.38 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (We looked at training in other areas. Some of the registered nurses had been trained )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (in dementia, venepuncture and wound care. There was little written evidence that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (registered nurses had been trained in suprapubic catheterisation or male )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (catheterisation, although residents with both types of catheter were cared for. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (training manager reported that they were sure that registered nurses had gained )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (qualifications in these areas, but that it had not been documented.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (More than one resident was being fed via an artificial feeding system, one resident )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (had a stoma and one resident was using a penile sheath. There was no evidence that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (staff had been trained in these areas, although care staff may be supporting the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (resident in managing such care needs. There was also no training documented in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (areas which residents experienced, such as pressure damage prevention, continence, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (stroke, diabetic or arthritis care. Records did not show that staff had been trained in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (activities provision, although they were performing this role. We discussed with the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (training manager about how staff were supported in learning about such areas. They )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (reported that they had put on such courses in the past, putting up notices to advise )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (staff about training, otherwise that training was performed "on the job" or at )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (handover. The home is not complying with national or local guidelines on prevention of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (pressure damage, so training is indicated in this area. Additionally when we discussed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (diabetic management with a registered nurse, they were not aware of current )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (guidelines in relation to the management of diabetes.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (Training is an area where the home needs to take action. This is to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (residents are fully supported by staff who have been trained to meet their needs. All )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (training needs to be fully documented to ensure that review and audit is possible.)Tj ET endstream endobj 93 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 94 0 obj <>stream 0 J 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 (40)Tj ET 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 1 1 1 RG 13.6 w 29.55 794.85 m 566.93 794.85 l S 0.001 w /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 785.57 Tm (Management and administration )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 10 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 29.55 766 Tm ()Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 747.89 Tm (These are the outcomes that people )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 250.51 747.89 Tm (staying in care homes)Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 383.43 747.89 Tm ( should experience. They )Tj ET 1 1 1 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 730.4 Tm (reflect the things that people have said are important to them:)Tj ET 1 1 1 RG 0.001 w 0 Tr /F6 5 Tf BT 1 0 0 1 28.35 717.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 189.25 w 32.32 618.88 m 562.53 618.88 l S 0.001 w 0.95294 0.95294 0.95294 RG 85 w 31.2 672.13 m 563.65 672.13 l S 0.001 w 1 1 1 RG 102 w 31.2 576.38 m 563.65 576.38 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 715.75 m 565.85 715.75 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 628.5 m 565.85 628.5 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 524.25 m 565.85 524.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 716.83 m 30.07 523.17 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.78 716.83 m 564.78 523.17 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 702.57 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 35.5 685.57 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 35.5 668.57 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 35.5 651.57 Tm (best interests. The environment is safe for people and staff because appropriate health )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 634.57 Tm (and safety practices are carried out.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 615.32 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 35.5 598.32 Tm (appropriately with an open approach that makes them feel valued and respected. The )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 581.32 Tm (people staying at the home are safeguarded because it follows clear financial and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 564.32 Tm (accounting procedures, keeps records appropriately and ensures their staff understand )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 547.32 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 35.5 530.32 Tm (supervised and supported by their managers.)Tj ET /F1 12 Tf BT 1 0 0 1 28.35 506 Tm ()Tj ET /F1 12 Tf BT 1 0 0 1 28.35 484 Tm (7KLVLVZKDWSHRSOHVWD\\LQJLQWKLVFDUHKRPHH[SHULHQFH)Tj ET /F1 12 Tf BT 1 0 0 1 369.04 484 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 461.94 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 124.35 w 34.6 395 m 562.54 395 l S 0.001 w 1 1 1 RG 22.5 w 32.35 448.17 m 564.79 448.17 l S 0.001 w 101.85 w 33.47 383.75 m 563.66 383.75 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 435.8 m 565.87 435.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 436.88 m 32.35 330.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 436.88 m 564.79 330.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 435.8 m 564.79 435.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 331.7 m 565.87 331.7 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 444.86 Tm (Judgement:)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 420.12 Tm (People using this service experience )Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 259.17 420.12 Tm (poor)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 290.57 420.12 Tm (quality outcomes in this area. We have )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 402.62 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 36.62 375.75 Tm (People could be put at risk as the home does not demonstrate that effective systems )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 358.25 Tm (for management are working across a range of areas, particularly in relation to health, )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 340.76 Tm (safety and welfare of people.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 316.01 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 223.8 w 34.6 193.93 m 562.54 193.93 l S 0.001 w 1 1 1 RG 22.5 w 32.35 296.83 m 564.79 296.83 l S 0.001 w 202.43 w 33.47 182.12 m 563.66 182.12 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 284.45 m 565.87 284.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 285.53 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 285.53 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 284.45 m 564.79 284.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 79.78 m 565.87 79.78 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 293.52 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 268.77 Tm (Goatacre Manor is owned by an established provider who has been in the business of )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 251.27 Tm (providing care for many years. A relative reported that the provider had "gone to so )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 233.78 Tm (much trouble to give individual patients special encouragement". The home has a )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 216.28 Tm (registered manager, Mrs Swainson, who has been in post for several years and is also )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 198.79 Tm (a registered nurse. One resident commented to us "manager, admin & chef really )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 181.29 Tm (good".)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 163.79 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 146.3 Tm (During this inspection, we discussed the previous inspection report with Mrs Swainson )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 128.8 Tm (and the fact that there were two requirements which had not been met within their )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 111.31 Tm (specified timescales and that progress was still needed in meeting our good practice )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 93.81 Tm (recommendations. We advised her that as statutory requirements had not been met )Tj ET endstream endobj 95 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 96 0 obj <>stream 0 J 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 (41)Tj ET 0.75294 0.75294 0.75294 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (within timescales, if they continued to be un-met at the next inspection, we would be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (taking action within our procedures to ensure that they were addressed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (We discussed other management arrangements and concerns which had arisen from )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (this inspection. We informed her that as pressure ulceration is a matter that can )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (adversely affect a residents' well-being, under our legislation, we need to be informed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (of every instance, in accordance with our notification processes. A registered nurse we )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (spoke with was not aware of the notification process to us for the medication error )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (which was identified at this inspection, and that as the manager may not be on duty at )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (all times, people who may be in charge of the home need training in their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (management responsibilities in this area.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (The home has an administrator, who includes management of residents' own finances )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (within their role. The home offers choice to residents, they will look after residents' )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (moneys or the resident or family can do this. Where a resident wishes to look after )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (their own moneys, the home offers the resident a lockable cash box. If the home looks )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (after residents' moneys, this is held in individual bank accounts. The home has a clear )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (system for managing residents' finances, with a full audit trail from invoices for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (services such as the hairdressing, chiropody or newspapers, to the resident's own )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (account. The administrator reported that they perform an audit three monthly and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (perform a reconciliation, which is double checked. Where cheques or cash are handed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (in by relatives at evenings or the weekend, there is a secure cupboard, to which the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (registered nurse in charge of the home has access, and receipts are given.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (At the previous inspection, the home were required to devise and implement an )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (effective quality assurance system. The administrator reported that they have sent out )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (questionnaires to residents and their supporters, that four had been returned so far )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (and that when more had been returned, she would collate the responses. As noted in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (health and personal care above, the home have commenced an audit of management )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (of medicines, however due to the issues identified at this inspection, it has clearly not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (been implemented in full. They also report in their AQAA that they are reviewing care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (plans, but this inspection indicates that more action is needed in this area. The home )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (have provided us with a full and detailed annual quality assessment, however )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (evidence from this inspection indicates that some parts of the assessment has not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (properly considered a range of issues relating to service provision.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (We looked at systems for ensuring health and safety in the home. There are records )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (to show that equipment and services such as the lifts, hoists for manual handling and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (fire safety take place. We looked at the hot water temperature records and noted that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (a wide range showed temperatures of over 42C, with no evidence of what actions had )Tj ET endstream endobj 98 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 99 0 obj <>stream 0 J 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 (42)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 728.25 w 34.6 447.28 m 562.54 447.28 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 706.88 w 33.47 435.47 m 563.66 435.47 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 79.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 80.9 m 565.87 80.9 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (been taken about these observations, this included both assisted bathrooms where )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (temperatures of 43.9C and 45.8C had been documented. As frail elderly people can be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (placed at risk of scalding if they are immersed in hot water, there need to be clear )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (indications of what actions have taken place, to address records of excessive hot )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (water temperatures. We asked for records of checks on shower heads, but it appeared )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (that there were no records relating to this. Shower heads need to be regularly )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (checked for the presence of lime scale and if deposits are identified, the must be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (removed, to reduce risk of Legionellum.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (During the inspection, we observed several staff manoevering wheelchairs by lifting )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (them by their rear handles. This is regarded as unsafe practice in manual handling. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (Just before lunch, we observed two care staff bring a resident into the sitting room. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (They put their arms under the person's shoulders to lift them up. Then, apparently )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (after noticing us, tried to encourage the resident to stand themselves, but the resident )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (was not able to do so, so transferring the resident to their armchair was complex, both )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (for staff and the resident. We reviewed this resident's care plan, which stated that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (they must always be transferred using a lifting belt, which the staff had not done. As )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (noted in Staffing above, not all staff have received mandatory manual handling )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (training, so this may be a factor in what we observed. The home must take action by )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (training and staff supervision to ensure that staff comply in full with care plans and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (perform safe manual handling practice at all times.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (As noted in Environment above, we noted a range of practices which indicated )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (developments are needed to ensure risk of infection is fully reduced. A review 25 )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (records did indicate that 20 staff had recently been trained in the area but )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (observations indicate that quality of training and closer supervision of staff practice is )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (needed.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (We observed that staff consistently used foot plates on wheelchairs when moving )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (residents about the home. We asked about monthly checks on wheelchairs and were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (advised that this had been delegated to a specific carer. People we spoke with were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (not sure if records were kept of these checks. As there is a body of evidence to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (indicate that people can be put at risk by wheelchairs which are not regularly checked )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (and serviced. There need to be full records of checks made and actions taken to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (address any deficits.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (At the last inspection, the home were recommended to review their bed rail records )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (and up-date them in line with national guidelines. During the inspection, we observed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (that several residents who spent all or most of their time had safety rails in place. All )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (of the safety rails in the four different rooms that we inspected were loose in their )Tj ET endstream endobj 100 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 101 0 obj <>stream 0 J 0.75294 0.75294 0.75294 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 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 456.46 52.04 Tm ()Tj ET /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 (43)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 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 (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F5 10 Tf BT 1 0 0 1 28.35 37.61 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 511.26 w 34.6 555.78 m 562.54 555.78 l S 0.001 w 1 1 1 RG 22.5 w 32.35 802.41 m 564.79 802.41 l S 0.001 w 489.89 w 33.47 543.96 m 563.66 543.96 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 790.03 m 565.87 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 791.11 m 32.35 296.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 296.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 790.03 m 564.79 790.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.27 297.89 m 565.87 297.89 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 799.09 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 779.1 Tm (fixings. Several of the safety rails had a significant gap between the head end of the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (bed and the safety rail. One resident had an air mattress and this had elevated their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (height in bed, so that they were positioned close to the top of the safety rail. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (Residents had assessments for safety rails, one of which had been reviewed and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (evaluated, however others had not been reviewed recently. One person who had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (bruising noted on their arms did not have protection to their safety rail, this was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (reported to relate to their medical condition, but no assessment of this had been made )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (in their bed rail care plan. We asked about checks on bed rails and were advised that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (this had been delegated to a care assistant, but people were not sure if records of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (these checks were maintained. Bed rails have been associated with a high level of risk )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (to people and there is a large body of evidence to show that people have been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (seriously harmed or worse by their unsafe or inappropriate use. Therefore, they must )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (always be used safely and care plans relating to their sure be accurate and regularly )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (up-dated. Any person who checks bed-rails needs to be fully trained in their role.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (We reviewed the home's accident records. An audit of accidents takes place, but the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (audit does not include time of day or day of the week, to assess if accident happened )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (more at certain time of the day or certain days of the week, such as weekends. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (observed several reports of "found on floor", which did not state which side the person )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (was found in or any equipment/furniture involved. It is advisable for accident records )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (to detail all factors involved in a fall. These was also no evidence that accidents to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (residents were reviewed at 24 and 48 hours, which is regarded as good practice, as )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (some injuries to elderly people may not be evidence until some time after the event.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (We observed that one registered nurse had sustained a needle-stick injury a few )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (weeks before the inspection. There was no evidence of follow-up relating to this injury )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (for the nurse. The Health and Safety Executive states that the employer must provide )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (effective and accessible services to staff in the event of a needle-stick injury.)Tj ET endstream endobj 102 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 104 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (44)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.99216 0.9451 0.76078 RG 36.25 w 29.47 793.28 m 564.97 793.28 l S 0.001 w 0.95294 0.95294 0.95294 RG 17 w 28.35 804.03 m 566.1 804.03 l S 0.001 w 17 w 28.35 784.78 m 422.1 784.78 l S 0.001 w 17 w 424.35 784.78 m 467.1 784.78 l S 0.001 w 1 1 1 RG 17 w 469.35 784.78 m 494.1 784.78 l S 0.001 w 0.95294 0.95294 0.95294 RG 17 w 496.35 784.78 m 539.1 784.78 l S 0.001 w 1 1 1 RG 17 w 541.35 784.78 m 566.1 784.78 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 26.14 794.4 m 568.3 794.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 813.65 m 568.3 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 794.4 m 568.3 794.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 26.14 775.15 m 568.3 775.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 27.22 814.73 m 27.22 774.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 423.22 795.48 m 423.22 774.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 468.22 795.48 m 468.22 774.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 495.22 795.48 m 495.22 774.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 540.22 795.48 m 540.22 774.08 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 814.73 m 567.22 774.08 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 33.75 800.47 Tm (Are there any outstanding requirements from the last inspection?)Tj ET /F2 12 Tf BT 1 0 0 1 429.75 781.22 Tm (Yes)Tj ET /F7 12 Tf BT 1 0 0 1 476.37 783.16 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 501.75 781.22 Tm (No)Tj ET /F7 12 Tf BT 1 0 0 1 546.75 783.16 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 590.79 w 32.32 422.01 m 564.97 422.01 l S 0.001 w 1 1 1 RG 227.7 w 31.2 500.7 m 91.05 500.7 l S 0.001 w 227.7 w 93.3 500.7 m 197.4 500.7 l S 0.001 w 227.7 w 199.65 500.7 m 289.45 500.7 l S 0.001 w 227.7 w 291.7 500.7 m 473.8 500.7 l S 0.001 w 227.7 w 476.05 500.7 m 566.1 500.7 l S 0.001 w 256.86 w 31.2 256.17 m 91.05 256.17 l S 0.001 w 256.86 w 93.3 256.17 m 197.4 256.17 l S 0.001 w 256.86 w 199.65 256.17 m 289.45 256.17 l S 0.001 w 256.86 w 291.7 256.17 m 473.8 256.17 l S 0.001 w 256.86 w 476.05 256.17 m 566.1 256.17 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 385.72 m 568.3 385.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 616.75 m 30.07 125.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 616.75 m 567.22 125.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 648.22 m 568.4 648.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 615.67 m 568.3 615.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 616.75 m 92.17 125.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 616.75 m 198.52 125.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 616.75 m 290.57 125.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 616.75 m 474.92 125.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 719.65 m 568.4 719.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 648.22 m 568.4 648.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 615.67 m 568.4 615.67 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 385.72 m 568.3 385.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 126.61 m 568.3 126.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 720.73 m 30.07 614.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 649.3 m 92.12 614.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 649.3 m 198.52 614.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 649.3 m 290.62 614.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 649.3 m 475.02 614.6 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 720.73 m 567.32 614.6 l S 0.001 w [] 0 d /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 702.45 Tm (Outstanding statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 684.03 Tm (These are requirements that were set at the previous inspection, but have still not )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 669.45 Tm (been met.)Tj ET /F2 12 Tf BT 1 0 0 1 95.57 669.45 Tm ( )Tj ET /F2 12 Tf BT 1 0 0 1 104.02 669.45 Tm (They say what the registered person had to do to meet the Care Standards )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 654.87 Tm (Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 637.05 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 634.05 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 634.05 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 634.05 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 634.05 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 621.9 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 602.49 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 599.49 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 599.49 Tm (12-113-2)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 599.49 Tm (Clear and objective )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 584.91 Tm (guidelines must be available )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 570.33 Tm (for the use of all "as )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 555.75 Tm (required" medications, to )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 541.17 Tm (promote their consistent use.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 526.59 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 509.01 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 494.43 Tm (Registered nurses need to )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 479.85 Tm (follow clear guidelines on )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 465.27 Tm (when and why to administer )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 450.69 Tm (such medications, so that the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 436.11 Tm (person is given such drugs in )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 421.53 Tm (a consistent manner, in )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 406.95 Tm (accordance with their )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 392.37 Tm (individual needs.)Tj ET /F2 12 Tf BT 1 0 0 1 478.9 599.49 Tm (02/05/2007)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 372.54 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 369.54 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 369.54 Tm (7 9 19Sch 2)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 369.54 Tm (Staff records must contain )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 354.96 Tm (evidence that all required )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 340.38 Tm (recruitment checks have )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 325.8 Tm (been completed for all )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 311.22 Tm (employees.)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 296.64 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 279.06 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 264.48 Tm (Procedures have been )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 249.9 Tm (established to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 235.32 Tm (people are safeguarded by )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 220.74 Tm (standard recruitment )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 206.16 Tm (procedures, so that only )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 191.58 Tm (people who are suitable to do )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 177 Tm (so, work with vulnerable )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 162.42 Tm (people. If these procedures )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 147.84 Tm (are not carried out residents )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 133.26 Tm (may be put at risk.)Tj ET /F2 12 Tf BT 1 0 0 1 478.9 369.54 Tm (02/05/2007)Tj ET endstream endobj 105 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 106 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (45)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 797.57 Tm (Requirements and recommendations from this inspection:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 782.15 Tm ()Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 108.12 w 32.32 719.78 m 564.97 719.78 l S 0.001 w 1 1 1 RG 20.58 w 31.2 677.13 m 91.05 677.13 l S 0.001 w 20.58 w 93.3 677.13 m 197.4 677.13 l S 0.001 w 20.58 w 199.65 677.13 m 289.45 677.13 l S 0.001 w 20.58 w 291.7 677.13 m 473.8 677.13 l S 0.001 w 20.58 w 476.05 677.13 m 566.1 677.13 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 30.07 689.63 m 30.07 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 689.63 m 567.22 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 721.1 m 568.4 721.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 688.55 m 568.3 688.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 689.63 m 92.17 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 689.63 m 198.52 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 689.63 m 290.57 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 689.63 m 474.92 664.64 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 776.09 m 568.4 776.09 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 721.1 m 568.4 721.1 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 688.55 m 568.4 688.55 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 665.72 m 568.3 665.72 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 777.17 m 30.07 687.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 722.18 m 92.12 687.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 722.18 m 198.52 687.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 722.18 m 290.62 687.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 722.18 m 475.02 687.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 777.17 m 567.32 687.47 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 759.9 Tm (Immediate requirements:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 742.32 Tm (These are immediate requirements that were set on the day we visited this care home. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 727.74 Tm (The registered person had to meet these within 48 hours.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 709.92 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 706.92 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 706.92 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 706.92 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 706.92 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 694.77 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 675.36 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 96.15 672.36 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 202.5 672.36 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 672.36 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 478.9 672.36 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 563.19 w 32.32 345.62 m 564.97 345.62 l S 0.001 w 1 1 1 RG 204 w 31.2 424.8 m 91.05 424.8 l S 0.001 w 204 w 93.3 424.8 m 197.4 424.8 l S 0.001 w 204 w 199.65 424.8 m 289.45 424.8 l S 0.001 w 204 w 291.7 424.8 m 473.8 424.8 l S 0.001 w 204 w 476.05 424.8 m 566.1 424.8 l S 0.001 w 257.65 w 31.2 191.73 m 91.05 191.73 l S 0.001 w 257.65 w 93.3 191.73 m 197.4 191.73 l S 0.001 w 257.65 w 199.65 191.73 m 289.45 191.73 l S 0.001 w 257.65 w 291.7 191.73 m 473.8 191.73 l S 0.001 w 257.65 w 476.05 191.73 m 566.1 191.73 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 321.68 m 568.3 321.68 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 529.01 m 30.07 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 529.01 m 567.22 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 560.48 m 568.4 560.48 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 527.93 m 568.3 527.93 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 529.01 m 92.17 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 529.01 m 198.52 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 529.01 m 290.57 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 529.01 m 474.92 60.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 629.47 m 568.4 629.47 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 560.48 m 568.4 560.48 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 527.93 m 568.4 527.93 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 321.68 m 568.3 321.68 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 30.07 630.55 m 30.07 526.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 561.56 m 92.12 526.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 561.56 m 198.52 526.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 561.56 m 290.62 526.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 561.56 m 475.02 526.85 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 630.55 m 567.32 526.85 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 616.28 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 596.28 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 34.05 581.7 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 581.7 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 567.12 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 549.3 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 546.3 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 546.3 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 546.3 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 546.3 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 534.15 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 514.74 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 514.74 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 514.74 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 514.74 Tm (The home's statement of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 497.74 Tm (purpose and service users' )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 480.74 Tm (guide must be fully revised, )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 463.74 Tm (to ensure that they comply )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 446.74 Tm (with our legislation.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 429.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 412.74 Tm (People need to be fully )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 395.74 Tm (informed about the services )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 378.74 Tm (provided by the home, so )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 361.74 Tm (that they can decide if the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 344.74 Tm (home can meet their, or )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 327.74 Tm (their relative's needs.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 514.74 Tm (31/08/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 514.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 308.49 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 308.49 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 308.49 Tm (14)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 308.49 Tm (All people must have a full )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 291.49 Tm (and detailed assessment of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 274.49 Tm (their nursing and care needs )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 257.49 Tm (prior to or immediately after )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 240.49 Tm (admission.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 223.49 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 206.49 Tm (Unless a person's nursing )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 189.49 Tm (and care needs have been )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 172.49 Tm (fully assessed, staff will not )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 155.49 Tm (be in a position to develop )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 138.49 Tm (plans of care on how the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 121.49 Tm (person's needs are to be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 104.49 Tm (met. People will therefore be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 87.49 Tm (placed at risk of not having )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 308.49 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 308.49 Tm ()Tj ET endstream endobj 107 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 108 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (46)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 746.25 w 32.32 438.28 m 564.97 438.28 l S 0.001 w 1 1 1 RG 34 w 31.2 693.99 m 91.05 693.99 l S 0.001 w 34 w 93.3 693.99 m 197.4 693.99 l S 0.001 w 34 w 199.65 693.99 m 289.45 693.99 l S 0.001 w 34 w 291.7 693.99 m 473.8 693.99 l S 0.001 w 34 w 476.05 693.99 m 566.1 693.99 l S 0.001 w 204 w 31.2 572.74 m 91.05 572.74 l S 0.001 w 204 w 93.3 572.74 m 197.4 572.74 l S 0.001 w 204 w 199.65 572.74 m 289.45 572.74 l S 0.001 w 204 w 291.7 572.74 m 473.8 572.74 l S 0.001 w 204 w 476.05 572.74 m 566.1 572.74 l S 0.001 w 357 w 31.2 289.99 m 91.05 289.99 l S 0.001 w 357 w 93.3 289.99 m 197.4 289.99 l S 0.001 w 357 w 199.65 289.99 m 289.45 289.99 l S 0.001 w 357 w 291.7 289.99 m 473.8 289.99 l S 0.001 w 357 w 476.05 289.99 m 566.1 289.99 l S 0.001 w 45.21 w 31.2 86.63 m 91.05 86.63 l S 0.001 w 45.21 w 93.3 86.63 m 197.4 86.63 l S 0.001 w 45.21 w 199.65 86.63 m 289.45 86.63 l S 0.001 w 45.21 w 291.7 86.63 m 473.8 86.63 l S 0.001 w 45.21 w 476.05 86.63 m 566.1 86.63 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 675.86 m 568.3 675.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 469.61 m 568.3 469.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 110.36 m 568.3 110.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 675.86 m 568.3 675.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 469.61 m 568.3 469.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 110.36 m 568.3 110.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 568.3 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 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 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 295.8 701.18 Tm (their individual nursing and )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 684.18 Tm (care needs met.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 662.68 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 662.68 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 662.68 Tm (15)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 662.68 Tm (Where a person's needs )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 645.68 Tm (have changed, their care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 628.68 Tm (plan must be evaluated and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 611.68 Tm (amended.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm (If care plans are not )Tj ET /F2 12 Tf BT 1 0 0 1 425.1 577.68 Tm (up-to-)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm (date)Tj ET /F2 12 Tf BT 1 0 0 1 324.61 560.68 Tm ( staff will not be fully )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm (informed of how to meet )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (individuals' care needs and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (these is a risk that care will )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm (not be provided in a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.68 Tm (consistent manner.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 662.68 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 662.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 456.43 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 456.43 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 456.43 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 456.43 Tm (All residents must have a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 439.43 Tm (full assessment of their )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 422.43 Tm (nursing and care needs. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 405.43 Tm (Assessments must include )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 388.43 Tm (all areas relating to care and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 371.43 Tm (risk for the resident. They )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 354.43 Tm (must be accurately )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 337.43 Tm (completed, signed and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 320.43 Tm (reviewed regularly or when )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 303.43 Tm (a resident's condition )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 286.43 Tm (changed.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 269.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 252.43 Tm (If residents' needs and risks )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 235.43 Tm (are not assessed or )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 218.43 Tm (reviewed when their )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 201.43 Tm (condition changes, the home )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 184.43 Tm (will not be in a position to )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 167.43 Tm (develop an adequate plan of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 150.43 Tm (care as to how the person's )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 133.43 Tm (need is to be met or risk )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 116.43 Tm (reduced.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 456.43 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 456.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 97.18 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 97.18 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 97.18 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 97.18 Tm (Where a person has a need )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 80.18 Tm (or a risk identified, there )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 97.18 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 97.18 Tm ()Tj ET endstream endobj 109 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 110 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (47)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 746.25 w 32.32 438.28 m 564.97 438.28 l S 0.001 w 1 1 1 RG 493 w 31.2 464.49 m 91.05 464.49 l S 0.001 w 493 w 93.3 464.49 m 197.4 464.49 l S 0.001 w 493 w 199.65 464.49 m 289.45 464.49 l S 0.001 w 493 w 291.7 464.49 m 473.8 464.49 l S 0.001 w 493 w 476.05 464.49 m 566.1 464.49 l S 0.001 w 151.71 w 31.2 139.88 m 91.05 139.88 l S 0.001 w 151.71 w 93.3 139.88 m 197.4 139.88 l S 0.001 w 151.71 w 199.65 139.88 m 289.45 139.88 l S 0.001 w 151.71 w 291.7 139.88 m 473.8 139.88 l S 0.001 w 151.71 w 476.05 139.88 m 566.1 139.88 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 216.86 m 568.3 216.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 216.86 m 568.3 216.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 568.3 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 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 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. 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The home does )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 271.68 Tm (have an audit system, but )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 254.68 Tm (this inspection indicates that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 237.68 Tm (it has not been robust in its )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 220.68 Tm (approach and action now )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 203.68 Tm (needs to be taken to ensure )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 186.68 Tm (good practice and safety in )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 169.68 Tm (the management of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 152.68 Tm (medicines.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 441.68 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 441.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 133.43 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 133.43 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 133.43 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 133.43 Tm (A documentary system for )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 116.43 Tm (administration of prescribed )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 99.43 Tm (topical applications must be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 82.43 Tm (developed and such )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 133.43 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 133.43 Tm ()Tj ET endstream endobj 113 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 114 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (49)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 746.25 w 32.32 438.28 m 564.97 438.28 l S 0.001 w 1 1 1 RG 238 w 31.2 591.99 m 91.05 591.99 l S 0.001 w 238 w 93.3 591.99 m 197.4 591.99 l S 0.001 w 238 w 199.65 591.99 m 289.45 591.99 l S 0.001 w 238 w 291.7 591.99 m 473.8 591.99 l S 0.001 w 238 w 476.05 591.99 m 566.1 591.99 l S 0.001 w 153 w 31.2 394.24 m 91.05 394.24 l S 0.001 w 153 w 93.3 394.24 m 197.4 394.24 l S 0.001 w 153 w 199.65 394.24 m 289.45 394.24 l S 0.001 w 153 w 291.7 394.24 m 473.8 394.24 l S 0.001 w 153 w 476.05 394.24 m 566.1 394.24 l S 0.001 w 187 w 31.2 221.99 m 91.05 221.99 l S 0.001 w 187 w 93.3 221.99 m 197.4 221.99 l S 0.001 w 187 w 199.65 221.99 m 289.45 221.99 l S 0.001 w 187 w 291.7 221.99 m 473.8 221.99 l S 0.001 w 187 w 476.05 221.99 m 566.1 221.99 l S 0.001 w 62.21 w 31.2 95.13 m 91.05 95.13 l S 0.001 w 62.21 w 93.3 95.13 m 197.4 95.13 l S 0.001 w 62.21 w 199.65 95.13 m 289.45 95.13 l S 0.001 w 62.21 w 291.7 95.13 m 473.8 95.13 l S 0.001 w 62.21 w 476.05 95.13 m 566.1 95.13 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 471.86 m 568.3 471.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 316.61 m 568.3 316.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 127.36 m 568.3 127.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 471.86 m 568.3 471.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 316.61 m 568.3 316.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 127.36 m 568.3 127.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 568.3 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 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 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. 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As these are )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 565.18 Tm (prescribed medication, there )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 548.18 Tm (must be documentary )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 531.18 Tm (evidence that the prescribed )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 514.18 Tm (applications have been )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 497.18 Tm (administered in accordance )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 480.18 Tm (with the person's needs.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 458.68 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 458.68 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 458.68 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.68 Tm (Medicines must always be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 441.68 Tm (securely stored.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 424.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 407.68 Tm (There are clear guidelines )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 390.68 Tm (relating to safe storage of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 373.68 Tm (medicines. 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0.001 w [] 0 d [] 0 d 2.25 w 28.99 452.61 m 568.3 452.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 161.36 m 568.3 161.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 568.3 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 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 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 295.8 701.18 Tm (and be aware of their )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 684.18 Tm (individual responsibilties )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 667.18 Tm (towards vulnerable people )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 650.18 Tm (so that they can ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 633.18 Tm (they are safeguarded.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 611.68 Tm (15)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 611.68 Tm (26)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 611.68 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 611.68 Tm (Staff must always use )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.68 Tm (utensils or gloves when )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm (handling food.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm (Food-stuffs must always be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (handled in a safe manner, )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (otherwise there is a risk of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm (contamination, which has )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.68 Tm (the potential to affect )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.68 Tm (people' health.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 611.68 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 611.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 439.43 Tm (16)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 439.43 Tm (26)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 439.43 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 439.43 Tm (The home must ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 422.43 Tm (systems and equipment are )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 405.43 Tm (in place and that staff )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 388.43 Tm (adhere to appropriate )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 371.43 Tm (principals for prevention of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 354.43 Tm (spread of infection, including )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 337.43 Tm (avoiding communal use of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 320.43 Tm (commonly used equipment )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 303.43 Tm (and clothing. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 286.43 Tm (If appropriate systems and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 269.43 Tm (equipment are not in place )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 252.43 Tm (to ensure that staff adhere )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 235.43 Tm (to the principals of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 218.43 Tm (prevention of cross infection, )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 201.43 Tm (there will be a risk to )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 184.43 Tm (residents.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 167.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 482.1 439.43 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 439.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 148.18 Tm (17)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 148.18 Tm (26)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 148.18 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 148.18 Tm (There must be safe practice )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 131.18 Tm (in the management of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 114.18 Tm (laundry. Infected linen must )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 97.18 Tm (always be separated at )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 80.18 Tm (source. Clean linen must )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 148.18 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 148.18 Tm ()Tj ET endstream endobj 122 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 123 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (53)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 746.25 w 32.32 438.28 m 564.97 438.28 l S 0.001 w 1 1 1 RG 153 w 31.2 634.49 m 91.05 634.49 l S 0.001 w 153 w 93.3 634.49 m 197.4 634.49 l S 0.001 w 153 w 199.65 634.49 m 289.45 634.49 l S 0.001 w 153 w 291.7 634.49 m 473.8 634.49 l S 0.001 w 153 w 476.05 634.49 m 566.1 634.49 l S 0.001 w 306 w 31.2 402.74 m 91.05 402.74 l S 0.001 w 306 w 93.3 402.74 m 197.4 402.74 l S 0.001 w 306 w 199.65 402.74 m 289.45 402.74 l S 0.001 w 306 w 291.7 402.74 m 473.8 402.74 l S 0.001 w 306 w 476.05 402.74 m 566.1 402.74 l S 0.001 w 183.46 w 31.2 155.76 m 91.05 155.76 l S 0.001 w 183.46 w 93.3 155.76 m 197.4 155.76 l S 0.001 w 183.46 w 199.65 155.76 m 289.45 155.76 l S 0.001 w 183.46 w 291.7 155.76 m 473.8 155.76 l S 0.001 w 183.46 w 476.05 155.76 m 566.1 155.76 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 556.86 m 568.3 556.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 248.61 m 568.3 248.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 556.86 m 568.3 556.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 248.61 m 568.3 248.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 568.3 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 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 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 295.8 701.18 Tm (always be separated from )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 684.18 Tm (used linen. )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 667.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 295.8 650.18 Tm (Laundries can present a )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 633.18 Tm (major risk to cross infection, )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 616.18 Tm (therefore systems and )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 599.18 Tm (practice must ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 582.18 Tm (risk is reduced to the lowest )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 565.18 Tm (possible level.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 543.68 Tm (18)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 543.68 Tm (26)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 543.68 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm (The home must perform a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (full review of its commode )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (chairs and take out of use )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm (any chairs and buckets )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.68 Tm (which cannot be properly )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.68 Tm (cleaned due to their )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 441.68 Tm (condition.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 424.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 407.68 Tm (Commode chairs can )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 390.68 Tm (present a risk to cross )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 373.68 Tm (infection and need to have )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 356.68 Tm (fully intact surfaces so that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 339.68 Tm (they can be wiped down. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 322.68 Tm (Commode chairs and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 305.68 Tm (buckets also need to be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 288.68 Tm (clean at all times so as to )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 271.68 Tm (promote residents' privacy )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 254.68 Tm (and dignity.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 543.68 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 543.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 235.43 Tm (19)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 235.43 Tm (26)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 235.43 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 235.43 Tm (The home must develop a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 218.43 Tm (clear written cleaning )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 201.43 Tm (schedules, to ensure that all )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 184.43 Tm (commode chairs, commode )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 167.43 Tm (buckets and hoists are )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 150.43 Tm (regularly cleaned.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 133.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 116.43 Tm (Communally used items can )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 99.43 Tm (present a risk of cross )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 82.43 Tm (infection, therefore there )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 235.43 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 235.43 Tm ()Tj ET endstream endobj 124 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 125 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (54)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 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61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 658.86 m 568.3 658.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 333.61 m 568.3 333.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 568.3 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 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 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 295.8 701.18 Tm (need to be systems in place )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 684.18 Tm (to ensure that they are )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 667.18 Tm (regularly cleaned.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 645.68 Tm (20)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 645.68 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 645.68 Tm (18)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 645.68 Tm (The home must provide )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 628.68 Tm (clear documentary evidence, )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 611.68 Tm (which are staff are aware of, )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.68 Tm (that a new member of staff )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm (is fully supervised during the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm (period after their pova )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm (clearance is returned and )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (before their CRB clearance is )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (returned.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.68 Tm (It is appreciated that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.68 Tm (receiving CRB clearance can )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 441.68 Tm (take time, therefore in order )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 424.68 Tm (to safeguard residents, a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 407.68 Tm (new member of staff may )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 390.68 Tm (commence work after pova )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 373.68 Tm (clearance has been )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 356.68 Tm (obtained, but only if they )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 339.68 Tm (are fully supervised. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 645.68 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 645.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 320.43 Tm (21)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 320.43 Tm (30)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 320.43 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 320.43 Tm (There must be records to )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 303.43 Tm (show that all staff have been )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 286.43 Tm (trained in manual handling )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 269.43 Tm (annually and all staff must )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 252.43 Tm (practice safe manual )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 235.43 Tm (handling practice at all )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 218.43 Tm (times, in accordance with )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 201.43 Tm (residents' individual care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 184.43 Tm (plans.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 167.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 150.43 Tm (Safe manual handling is a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 133.43 Tm (key area in protecting both )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 116.43 Tm (residents and staff. There )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 99.43 Tm (must be evidence that staff )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 82.43 Tm (have been trained in safe )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 320.43 Tm (31/08/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 320.43 Tm ()Tj ET endstream endobj 126 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 127 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (55)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 746.25 w 32.32 438.28 m 564.97 438.28 l S 0.001 w 1 1 1 RG 85 w 31.2 668.49 m 91.05 668.49 l S 0.001 w 85 w 93.3 668.49 m 197.4 668.49 l S 0.001 w 85 w 199.65 668.49 m 289.45 668.49 l S 0.001 w 85 w 291.7 668.49 m 473.8 668.49 l S 0.001 w 85 w 476.05 668.49 m 566.1 668.49 l S 0.001 w 204 w 31.2 521.74 m 91.05 521.74 l S 0.001 w 204 w 93.3 521.74 m 197.4 521.74 l S 0.001 w 204 w 199.65 521.74 m 289.45 521.74 l S 0.001 w 204 w 291.7 521.74 m 473.8 521.74 l S 0.001 w 204 w 476.05 521.74 m 566.1 521.74 l S 0.001 w 353.46 w 31.2 240.76 m 91.05 240.76 l S 0.001 w 353.46 w 93.3 240.76 m 197.4 240.76 l S 0.001 w 353.46 w 199.65 240.76 m 289.45 240.76 l S 0.001 w 353.46 w 291.7 240.76 m 473.8 240.76 l S 0.001 w 353.46 w 476.05 240.76 m 566.1 240.76 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 624.86 m 568.3 624.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 418.61 m 568.3 418.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 624.86 m 568.3 624.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 418.61 m 568.3 418.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 568.3 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 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 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. 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This assists )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 150.43 Tm (us in reviewing quality of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 133.43 Tm (service provision. Staff who )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 116.43 Tm (may be in charge of the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 99.43 Tm (home need to know what )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 82.43 Tm (actions to take under our )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 405.43 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 405.43 Tm ()Tj ET endstream endobj 128 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 129 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (56)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 732.79 w 32.32 445.01 m 564.97 445.01 l S 0.001 w 1 1 1 RG 51 w 31.2 685.49 m 91.05 685.49 l S 0.001 w 51 w 93.3 685.49 m 197.4 685.49 l S 0.001 w 51 w 199.65 685.49 m 289.45 685.49 l S 0.001 w 51 w 291.7 685.49 m 473.8 685.49 l S 0.001 w 51 w 476.05 685.49 m 566.1 685.49 l S 0.001 w 340 w 31.2 487.74 m 91.05 487.74 l S 0.001 w 340 w 93.3 487.74 m 197.4 487.74 l S 0.001 w 340 w 199.65 487.74 m 289.45 487.74 l S 0.001 w 340 w 291.7 487.74 m 473.8 487.74 l S 0.001 w 340 w 476.05 487.74 m 566.1 487.74 l S 0.001 w 238 w 31.2 196.49 m 91.05 196.49 l S 0.001 w 238 w 93.3 196.49 m 197.4 196.49 l S 0.001 w 238 w 199.65 196.49 m 289.45 196.49 l S 0.001 w 238 w 291.7 196.49 m 473.8 196.49 l S 0.001 w 238 w 476.05 196.49 m 566.1 196.49 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 658.86 m 568.3 658.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 316.61 m 568.3 316.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 75.29 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 658.86 m 568.3 658.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 316.61 m 568.3 316.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 76.36 m 568.3 76.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 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 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 295.8 701.18 Tm (procedures, as such events )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 684.18 Tm (can take place at any time )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 667.18 Tm (during the 24 hour period.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 645.68 Tm (24)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 645.68 Tm (33)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 645.68 Tm (24)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 645.68 Tm (An effective quality )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 628.68 Tm (assurance system must be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 611.68 Tm (developed, this must include )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.68 Tm (the home's systems for )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm (ensuring high quality of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm (nursing and clinical care. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm (Actions identified and plans )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (to address issues identified )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (need to be included.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.68 Tm (It is the home's )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.68 Tm (responsibility to ensure that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 441.68 Tm (it provides quality services, )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 424.68 Tm (which meet peoples' needs. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 407.68 Tm (In order to do this in an )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 390.68 Tm (effective manner, they must )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 373.68 Tm (impartially review their )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 356.68 Tm (service provision and take )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 339.68 Tm (action where matters are )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 322.68 Tm (identified.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 645.68 Tm (31/08/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 645.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 303.43 Tm (25)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 303.43 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 303.43 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 303.43 Tm (There must be records in )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 286.43 Tm (place to show that all )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 269.43 Tm (wheelchairs have been )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 252.43 Tm (regularly checked and any )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 235.43 Tm (deficits rectified.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 218.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 201.43 Tm (Wheelchairs can present a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 184.43 Tm (risk to people if they are not )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 167.43 Tm (regularly maintained. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 150.43 Tm (Therefore they need to have )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 133.43 Tm (regular written checks )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 116.43 Tm (undertaken and action take )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 99.43 Tm (where maintenance is )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 82.43 Tm (needed.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 303.43 Tm (31/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 303.43 Tm ()Tj ET endstream endobj 130 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 131 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (57)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 746.25 w 32.32 438.28 m 564.97 438.28 l S 0.001 w 1 1 1 RG 408 w 31.2 506.99 m 91.05 506.99 l S 0.001 w 408 w 93.3 506.99 m 197.4 506.99 l S 0.001 w 408 w 199.65 506.99 m 289.45 506.99 l S 0.001 w 408 w 291.7 506.99 m 473.8 506.99 l S 0.001 w 408 w 476.05 506.99 m 566.1 506.99 l S 0.001 w 236.71 w 31.2 182.38 m 91.05 182.38 l S 0.001 w 236.71 w 93.3 182.38 m 197.4 182.38 l S 0.001 w 236.71 w 199.65 182.38 m 289.45 182.38 l S 0.001 w 236.71 w 291.7 182.38 m 473.8 182.38 l S 0.001 w 236.71 w 476.05 182.38 m 566.1 182.38 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 301.86 m 568.3 301.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 301.86 m 568.3 301.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 62.9 m 568.3 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 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 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 698.93 Tm (26)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 698.93 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 698.93 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 698.93 Tm (Bed rails must always be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 681.93 Tm (safely used in accordance )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 664.93 Tm (with national guidelines. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 647.93 Tm (Care plans for their use )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 630.93 Tm (must be regularly and fully )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 613.93 Tm (evaluated. There must be a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 596.93 Tm (documentary system for )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 579.93 Tm (regular checks on bed rails. )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 562.93 Tm (There must be evidence that )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 545.93 Tm (people who check bed rails )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 528.93 Tm (have been trained in their )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 511.93 Tm (role.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 494.93 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 477.93 Tm (There is a large body of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 460.93 Tm (evidence about the risks to )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 443.93 Tm (people from the use of bed )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 426.93 Tm (rails, therefore they must )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 409.93 Tm (only be used if it can be )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 392.93 Tm (demonstrated that their use )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 375.93 Tm (is in the best interest of the )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 358.93 Tm (person and that all required )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 341.93 Tm (safety checks have been )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 324.93 Tm (performed by a person who )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 307.93 Tm (is qualified to do so. )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 698.93 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 698.93 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 288.68 Tm (27)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 288.68 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 288.68 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 288.68 Tm (The home must take )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 271.68 Tm (effective action to ensure )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 254.68 Tm (that people are protected )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 237.68 Tm (from the risks of scalding )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 220.68 Tm (from hot water )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 203.68 Tm (temperatures.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 186.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 169.68 Tm (Elderly people tend to have )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 152.68 Tm (thin and inelastic skin, some )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 135.68 Tm (people experience sensory )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 118.68 Tm (loss, particularly to their )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 101.68 Tm (extremities and some are )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 84.68 Tm (not able to communicate )Tj ET /F2 12 Tf BT 1 0 0 1 482.1 288.68 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 288.68 Tm ()Tj ET endstream endobj 132 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 133 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (58)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 492.54 w 32.32 565.13 m 564.97 565.13 l S 0.001 w 1 1 1 RG 102 w 31.2 659.99 m 91.05 659.99 l S 0.001 w 102 w 93.3 659.99 m 197.4 659.99 l S 0.001 w 102 w 199.65 659.99 m 289.45 659.99 l S 0.001 w 102 w 291.7 659.99 m 473.8 659.99 l S 0.001 w 102 w 476.05 659.99 m 566.1 659.99 l S 0.001 w 289 w 31.2 462.24 m 91.05 462.24 l S 0.001 w 289 w 93.3 462.24 m 197.4 462.24 l S 0.001 w 289 w 199.65 462.24 m 289.45 462.24 l S 0.001 w 289 w 291.7 462.24 m 473.8 462.24 l S 0.001 w 289 w 476.05 462.24 m 566.1 462.24 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 607.86 m 568.3 607.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 713.19 m 30.07 315.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 713.19 m 567.22 315.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.3 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 713.19 m 92.17 315.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 713.19 m 198.52 315.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 713.19 m 290.57 315.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 713.19 m 474.92 315.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 813.65 m 568.4 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 744.66 m 568.4 744.66 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 712.11 m 568.4 712.11 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 607.86 m 568.3 607.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 316.61 m 568.3 316.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 745.74 m 92.12 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 745.74 m 198.52 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 745.74 m 290.62 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 745.74 m 475.02 711.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 814.73 m 567.32 711.04 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 800.47 Tm (Statutory requirements)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 780.47 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 34.05 765.89 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 765.89 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 751.31 Tm (Standards. The registered person\(s\) must do this within the timescales we have set.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 733.49 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 730.49 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 730.49 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 730.49 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 730.49 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 718.34 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 295.8 701.18 Tm (with ease if they suffer )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 684.18 Tm (discomfort. Therefore the )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 667.18 Tm (home must set up systems )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 650.18 Tm (to ensure that people are )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 633.18 Tm (protected from risk of scalds )Tj ET /F2 12 Tf BT 1 0 0 1 295.8 616.18 Tm (from hot water.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 594.68 Tm (28)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 594.68 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 594.68 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 594.68 Tm (The home must set up a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 577.68 Tm (documentary system to )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 560.68 Tm (show that all shower heads )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 543.68 Tm (are regularly checked for )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 526.68 Tm (lime-scale and any )Tj ET /F2 12 Tf BT 1 0 0 1 415.92 526.68 Tm (lime-)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 509.68 Tm (scale)Tj ET /F2 12 Tf BT 1 0 0 1 328.2 509.68 Tm ( identified, removed.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 492.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 475.68 Tm (Shower heads in large )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 458.68 Tm (premises such as care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 441.68 Tm (homes can harbour )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 424.68 Tm (Legionellum, which can be a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 407.68 Tm (potentially very serious )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 390.68 Tm (illness, particularly if lime )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 373.68 Tm (scale is present. Therefore )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 356.68 Tm (there needs to be clear )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 339.68 Tm (records of the checking of )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 322.68 Tm (shower heads.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 594.68 Tm (30/06/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 594.68 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 221.65 w 32.32 186.54 m 564.97 186.54 l S 0.001 w 1 1 1 RG 35.16 w 31.2 192.06 m 91.05 192.06 l S 0.001 w 35.16 w 93.3 192.06 m 197.4 192.06 l S 0.001 w 35.16 w 199.65 192.06 m 566.1 192.06 l S 0.001 w 20.58 w 31.2 161.94 m 91.05 161.94 l S 0.001 w 20.58 w 93.3 161.94 m 197.4 161.94 l S 0.001 w 20.58 w 199.65 161.94 m 566.1 161.94 l S 0.001 w 35.16 w 31.2 131.82 m 91.05 131.82 l S 0.001 w 35.16 w 93.3 131.82 m 197.4 131.82 l S 0.001 w 35.16 w 199.65 131.82 m 566.1 131.82 l S 0.001 w 35.16 w 31.2 94.41 m 91.05 94.41 l S 0.001 w 35.16 w 93.3 94.41 m 197.4 94.41 l S 0.001 w 35.16 w 199.65 94.41 m 566.1 94.41 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 173.36 m 568.3 173.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 150.53 m 568.3 150.53 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 113.12 m 568.3 113.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 211.85 m 30.07 74.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 211.85 m 567.22 74.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 230.04 m 568.4 230.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 210.77 m 568.3 210.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 211.85 m 92.17 74.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 211.85 m 198.52 74.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 299.61 m 568.4 299.61 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 230.04 m 568.4 230.04 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 173.36 m 568.3 173.36 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 150.53 m 568.3 150.53 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 113.12 m 568.3 113.12 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 75.71 m 568.3 75.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 300.69 m 30.07 209.69 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 231.12 m 92.17 210.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.47 231.12 m 198.47 210.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 300.69 m 567.32 209.69 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 283.43 Tm (Recommendations)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 265.85 Tm (These recommendations are taken from the best practice described in the National )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 251.27 Tm (Minimum Standards and the registered person\(s\) should consider them as a way of )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 236.69 Tm (improving their service.)Tj ET /F2 10 Tf BT 1 0 0 1 34.05 215.87 Tm (No)Tj ET /F2 10 Tf BT 1 0 0 1 96.15 215.87 Tm (Refer to Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.45 215.87 Tm (Good Practice Recommendations)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 194.58 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 194.58 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 194.58 Tm (The clinical indicator for the use of a urinary catheter )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 180 Tm (should always be documented.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 157.17 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 157.17 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 157.17 Tm (Fluid charts should be totalled every 24 hours.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 134.34 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 134.34 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 134.34 Tm (Wounds should be regularly photographed to assist in )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 119.76 Tm (assessment of response to interventions.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 96.93 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 96.93 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 96.93 Tm (Documentation relating to pressure ulceration should )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 82.35 Tm (include an assessment of the grade of the ulcer.)Tj ET endstream endobj 134 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 135 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w 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drug, this )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 694.04 Tm (should always be recorded. )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 671.21 Tm (6)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 671.21 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 671.21 Tm (Where a person is being administered Digoxin, a record of )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 656.63 Tm (their pulse should always be documented.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 633.8 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 633.8 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 633.8 Tm (When medicines instructions are written or changed by )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 619.22 Tm (hand this should be signed and countersigned)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 596.39 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 596.39 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 596.39 Tm (Relatives should be fully informed of any significant events )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 581.81 Tm (which may affect the residents' health and welfare.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 558.98 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 558.98 Tm (14)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 558.98 Tm (Care plans should document full information about a )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 544.4 Tm (persons' wishes in relation to practice of religion.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 521.57 Tm (10)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 521.57 Tm (21)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 521.57 Tm (The home should consider widening its range of assisted )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 506.99 Tm (bathing facilities to meet the increasing disability needs of )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 492.41 Tm (the client group.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 469.58 Tm (11)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 469.58 Tm (22)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 469.58 Tm (The home should consider providing profiling beds to )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 455 Tm (reduce the risks associated with beds which cannot be )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 440.42 Tm (lowered close to the floor and have non-integral bed rails.)Tj ET /F2 12 Tf BT 1 0 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202.5 290.78 Tm (disinfector.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 267.95 Tm (16)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 267.95 Tm (30)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 267.95 Tm (The home should set up a clear management process )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 253.37 Tm (where by staff who do not attend mandatory or other )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 238.79 Tm (training programmes are advised of their and the provider's )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 224.21 Tm (responsibilities.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 201.38 Tm (17)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 201.38 Tm (30)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 201.38 Tm (The home should set up a matrix for training to facilitate )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 186.8 Tm (review of who was been trained in which areas and any )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 172.22 Tm (deficits.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 149.39 Tm (18)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 149.39 Tm (30)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 149.39 Tm (The training manager should receive training in their role.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 126.56 Tm (19)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 126.56 Tm (30)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 126.56 Tm (The home should further develop its induction programme, )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 111.98 Tm (to ensure that it can fully evidence that new members of )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 97.4 Tm (staff have received a comprehensive and structured )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 82.82 Tm (induction programme.)Tj ET endstream endobj 136 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 137 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (60)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf 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(The home should comply with health and safety guidelines )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 656.63 Tm (for staff if they sustain a needle stick injury.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 633.8 Tm (22)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 633.8 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 633.8 Tm (Where a person sustains an accident, full details of what )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 619.22 Tm (was observed should be documented, with a written follow )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 604.64 Tm (up on the person's condition after the accident.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 581.81 Tm (23)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 581.81 Tm (38)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 581.81 Tm (Audits of accident records should include a review of time )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 567.23 Tm (of day and day of the week.)Tj ET endstream endobj 138 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 139 0 obj <>stream 0 J 0.75294 0.75294 0.75294 RG 20.58 w 28.35 35.56 m 566.93 35.56 l S 0.001 w /F2 12 Tf 0 0 0 rg BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 30.79 Tm (Care Homes for Older People)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 477.68 31.8 Tm (Page)Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 508.21 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 11 Tf BT 1 0 0 1 522.2 31.8 Tm ( of )Tj ET /F2 11 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 540.49 31.8 Tm (61)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 22.5 w 22.95 802.41 m 560.45 802.41 l S 0.001 w /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 799.09 Tm (Helpline:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 10 Tf BT 1 0 0 1 28.35 781.11 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 759.6 Tm (Telephone:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 95.88 759.6 Tm ( 03000 616161)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 739.6 Tm (Email:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 66.84 739.6 Tm ( enquiries@cqc.org.uk)Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 28.35 719.61 Tm (Web:)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 64.35 719.61 Tm (www.cqc.org.uk)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 699.61 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 679.61 Tm (We want people to be able to access this information. If you would like a summary in a )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 662.12 Tm (different format or language please contact our helpline or go to our website.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 622.62 Tm (Copyright \(2009\) Care Quality Commission \(CQC\). This publication may be )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 605.13 Tm (reproduced in whole or in part, free of charge, in any format or medium provided that it )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 587.63 Tm (is not used for commercial gain. This consent is subject to the material being )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 570.13 Tm (reproduced accurately and on proviso that it is not used in a derogatory manner or )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 552.64 Tm (misleading context. 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C <RG<29Ap@AC6/?o /?o 7 9999PKKTBKKSB 2+KdRBKRXYKTXYKSXY++++st+ststEEha#DsEEha#DEEha#DEh#D+s+++++++++++++st++++++ssssssss+ss+s+++++st++++u++++++++++++++++++++t+st+sst+st+t+ss++st+s+++ss+++s++++s+++++++++++sttu++++++++++++++++++++++++++s+++++qEhq#Dstu++++ endstream endobj 144 0 obj<> endobj 145 0 obj<>/Subtype/CIDFontType2/Type/Font/W [3[312]]/CIDToGIDMap/Identity/DW 1000>> endobj 146 0 obj <>stream /CIDInit /ProcSet findresource begin 12 dict begin begincmap /CIDSystemInfo << /Registry (Adobe) /Ordering (UCS) /Supplement 0 >> def /CMapName /Adobe-Identity-UCS def /CMapType 2 def 1 begincodespacerange <0003><0003> endcodespacerange 1 beginbfrange <0003><0003><00a0> endbfrange endcmap CMapName currentdict /CMap defineresource pop end end endstream endobj 5 0 obj<> endobj 147 0 obj <>stream %!PS-AdobeFont-1.0: SymbolMT Typeface The Monotype Corporation plc. 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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Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: Fri Oct 10 11:48:26 2008 % Converted from TrueType font 'TIMES.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 2.76) readonly def /Notice (Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved) readonly def /FullName (Times New Roman) readonly def /FamilyName (Times New Roman) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -109 def /UnderlineThickness 49 def end readonly def /FontName /TimesNewRomanPSMT def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {-77 -216 1009 877} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /quotedbl put dup 35 /numbersign put dup 36 /dollar put dup 37 /percent put dup 38 /ampersand put dup 39 /quotesingle put dup 40 /parenleft put dup 41 /parenright put dup 42 /asterisk put dup 43 /plus put dup 44 /comma put dup 45 /hyphen put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /at put dup 65 /A put dup 66 /B put dup 67 /C put dup 68 /D put dup 69 /E put dup 70 /F put dup 71 /G put dup 72 /H put dup 73 /I put dup 74 /J put dup 75 /K put dup 76 /L put dup 77 /M put dup 78 /N put dup 79 /O put dup 80 /P put dup 81 /Q put dup 82 /R put dup 83 /S put dup 84 /T put dup 85 /U put dup 86 /V put dup 87 /W put dup 88 /X put dup 89 /Y put dup 90 /Z put dup 91 /bracketleft put dup 92 /backslash put dup 93 /bracketright put dup 94 /asciicircum put dup 95 /underscore put dup 96 /grave put dup 97 /a put dup 98 /b put dup 99 /c put dup 100 /d put dup 101 /e put dup 102 /f put dup 103 /g put dup 104 /h put dup 105 /i put dup 106 /j put dup 107 /k put dup 108 /l put dup 109 /m put dup 110 /n put dup 111 /o put dup 112 /p put dup 113 /q put dup 114 /r put dup 115 /s put dup 116 /t put dup 117 /u put dup 118 /v put dup 119 /w put dup 120 /x put dup 121 /y put dup 122 /z put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /asciitilde put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /quotesinglbase put dup 131 /florin put dup 132 /quotedblbase put dup 133 /ellipsis put dup 134 /dagger put dup 135 /daggerdbl put dup 136 /circumflex put dup 137 /perthousand put dup 138 /Scaron put dup 139 /guilsinglleft put dup 140 /OE put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /quoteleft put dup 146 /quoteright put dup 147 /quotedblleft put dup 148 /quotedblright put dup 149 /bullet put dup 150 /endash put dup 151 /emdash put dup 152 /tilde put dup 153 /trademark put dup 154 /scaron put dup 155 /guilsinglright put dup 156 /oe put dup 157 /.notdef put dup 158 /.notdef put dup 159 /Ydieresis put dup 160 /space put dup 161 /exclamdown put dup 162 /cent put dup 163 /sterling put dup 164 /currency put dup 165 /yen put dup 166 /brokenbar put dup 167 /section put dup 168 /dieresis put dup 169 /copyright put dup 170 /ordfeminine put dup 171 /guillemotleft put dup 172 /logicalnot put dup 173 /hyphen put dup 174 /registered put dup 175 /overscore put dup 176 /degree put dup 177 /plusminus put dup 178 /twosuperior put dup 179 /threesuperior put dup 180 /acute put dup 181 /mu1 put dup 182 /paragraph put dup 183 /periodcentered put dup 184 /cedilla put dup 185 /onesuperior put dup 186 /ordmasculine put dup 187 /guillemotright put dup 188 /onequarter put dup 189 /onehalf put dup 190 /threequarters put dup 191 /questiondown put dup 192 /Agrave put dup 193 /Aacute put dup 194 /Acircumflex put dup 195 /Atilde put dup 196 /Adieresis put dup 197 /Aring put dup 198 /AE put dup 199 /Ccedilla put dup 200 /Egrave put dup 201 /Eacute put dup 202 /Ecircumflex put dup 203 /Edieresis put dup 204 /Igrave put dup 205 /Iacute put dup 206 /Icircumflex put dup 207 /Idieresis put dup 208 /Eth put dup 209 /Ntilde put dup 210 /Ograve put dup 211 /Oacute put dup 212 /Ocircumflex put dup 213 /Otilde put dup 214 /Odieresis put dup 215 /multiply put dup 216 /Oslash put dup 217 /Ugrave put dup 218 /Uacute put dup 219 /Ucircumflex put dup 220 /Udieresis put dup 221 /Yacute put dup 222 /Thorn put dup 223 /germandbls put dup 224 /agrave put dup 225 /aacute put dup 226 /acircumflex put dup 227 /atilde put dup 228 /adieresis put dup 229 /aring put dup 230 /ae put dup 231 /ccedilla put dup 232 /egrave put dup 233 /eacute put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B TcJ6*]h[zeKq)ƷW0jlBIf14%B[tnqNOדe{fC;1I^7^r5=[ySwF 5ZUͧ@;J7{Phx ғ*⿅΅V1lCd3Dk9+ ~Iic*x 2YC.eKgt_"t!Ztb$~iS[xdw +P7)%g9/-awT=JK/{ Q'y!kA,7 Α$?H}Om"s*5aks*HRUufn6i?kɝ=-0X%lϧQ4ݡ`rџ~D&#&:t]=.ok &DZђԺŠRq [j@3a*42K]sjϖjG_n 4Ϛ5. *Ly^w`ܮ64r/:!?u:};ߜ`dӤJY2R'wbTCI2CRNY2uD-.Y9y:2Cʸ`ͻq5dBpQŰ: TimM;f ]+ozY0,(Fh^ GirY E W| -R̵vVP ce޾'zH+1= PU~}fIa 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C)L`Fsnwͮ\24WLPB~bۏnlẆ?t7%RjDT@Fy3!l!*]!xuvydy&WCn ;0Vռ/ %#d7x$ ޠʎ ih׼ \DOO}ՉK7|GV8Us6jqf,$F]Ǻ%kD:> s-rt\ږ؅nzV95[ɞ-{v"z@"A?ջ߃1>zL9jda;M=f~ܟ('_{EssH${FȆm{ _T*{pe>rSNеk 8vdWP#W -/ֺ5Y|:bh4c$9Zy`?}bŲoreMT*ubA::NǢ]ߧ%[N-~XO੫3ƒ+F=S<[<|m# =h^Ad+j)Yo!lQG92# .7҆N*%ݖTTz&E+?ۥP4tѥJdǀj:e7P/t(Iҍ9Pφ<8>A(vfCyLÆ(칡\ wtNYα9 |c~Nn}|;5!=2SF_If5.M+uh^|kp+w<@Rg mLe+36#w\M3!6Z8bL, 2OMz$ٙMYz֑"'N܌>gYst<qWU0HTH3kjsB?IU-#XcZ -?;#+mA"֞FgcѦ0{C@$TOOBuEWv{9l9v݇ KZ' 栦T_㭛of=͇%c)nQb[._1ڃz5{%nTA3boC׾ b`vM*xS5%ڃ,?92_@Iשͫ)705frK%׷[kKNd:@EP2KEҖP,Lj!EbF[. 5^8vu~@É7Osy4:]ûrl{SO`Du\ $ VX `3F`Q[k[k`*>AslR7ho59Q77t7Cu~fN"?>n=^Sl61 ~>ON x0_V8e2dOsUb<К1W<$wMhȧE@?y2BO㣌'B1}X^ޝ82*l%l"6V]uv@Tc^iB^: 6Pdj'SG4) 7󱼮6BMzpN*l Hzx +K?(Kh@Ze( pX>'O5jAkE\qG\#("vY{nݚQK1ϞP3td![M\Fx }Ga^`Ht"px:iWV7̠=tqDN^@T]69) sN| i٧Vv)fWB8 9r~']w0pҴӠ֖j`sK.a^rQQQvZ% k!0VS&wZFL*D*`}H(um@7͘LZ2Oo)HgQ]AA-{y [< jnRX=;:#R=֥mu,O+쩰aB0)=!udhZ| d|qE"Ep,zޅ[C|6ƥއ윺+z;4TXȲX3YEKQL֏{"MK:Mȅ ҆NЉD|BG1 Sּgh: e0ۏ뗳g:˹ag ٸych7VKNϯ!9fZSfա"ÒN+1ՕMMvV{vIH)xeq~@m%O+痷e66̠_KS6DlJ!Iu?0ήA:F {UH*_FUNт_NQGO _ܙH6m5iߊפ㨫RܳߺH[ܽϧ j֌ ?'#euDZyux[u:s`r&NaxAl mI0@<>"{0MoPR7 懥NKuVovzr_A4I%l Dcc)Oqϯ}TJVt]xWo9Y(vXch]H?4o𼋮àrchSej@*h!bL|hvgX pXFj81+VE*n8*W@2 "aJnǯ|CvmiW|ޠDŽ9sk_'bM3Ћ/O;Y rZJ:"һCnvXz@M^୩uivJ{E7_w2^0TOfɌ]iҹ\4 0+u:iME Gy9:¦=Bcc>?[ 06ϛbb-5|Xw]T 7lR**7iPlp7G}{c NC@cۨPi0Sy.Y͋~sf됑{=$)yeښN(ow"R h?WX°N ط-C۶v Ai㧩Τ|m)qLx;Oj2 En_Y">nqOWZEtky""mxů2 'Ϋ:Ž/hO rCs 5 Y#-geD;!C(X:êٯJ<GnBciޓzݎ")ڽ1KULBqK]ˎuEV0+7x:=X(GH6,974>\F[uG3W ci-A/iE8l7D6 /",U6: (CX fJHKxf'ۋKvtRa@ kɲEK-E]p$L3""Vo\yWC8f[({]t! fR8s6lρdGzSZPI9{ЉKL=L8" ᓔ6,Xbkg{)rǸ&(}KR*+B.v$8n6w&_IcyAMWȄ0jm8;'wbڹex81Xߋ˪ H܀]rָƢ#3GMo9*_qM>I!pMTIUJR3Q?yFs57S 4 ,dE SN?o(}X Ũ%xD]3nH b\u~ e#Jf=6-G7ZZx ~K::9f";w6xk%JeᮡCD5YySA63aF3JpStS=QNHJ'J$N4^7 J݁DxSLMD)1 :S@Bz,/SPmaC=ՓI3D/bpC% s8IFEwJP9j:!æJ*8/=&b-Pc|,&~9h]`*ӵlDwiQ˅ - Dz(=t2s92 3O/D $oX@vڊC*쩜:4<ƁLu Z[(Ikzb-$.5o1TX3quSr{/ňiEIVj!G(訚?\ ;=V KLvfΌԬ +X(b(1bG`ݹ9Ue76N+Vz&_l?V&'v=aApfXd7gqz[_d])B뿐ڣ5@(M`єZh 7(% nJtzT.̅5›pkcpv*83\/3ҜeNrc0W|/TZ+"πE%xxKyİ`0op( r ^VK_dGyұ]]z&a];iiN`>I)Abo)L8K15OzlmV 5]EoF ,tGٓ 1( (B75 q2PV\ KRy i&;IUOHNUw"u*J=xҨ ?b݄,Wܜ@t~ `$mst*,Dcrn TJ 1 M4t7pv$2wS3ˎTp@}qY^!T}?հƿ-/ގ ]΅O;>lCH7b(~o a_|W9zÓ(֎ ~a(kƟ<w5+$Nn1$W6_;4۴%~6xH-tM`v _6!&-H ;at1 V 뵾Nw[unF.(^ T1h!E[i5$.b]/x]}p{![,eR/W*vQРT)|:7 QJ ?(,y$_ -A"q~`BX@-&: `lj_k~-MT,G ́ ?"-UϠWR?Ycx Z$lYAm^#tVp\OY F<~%ROU*<(xN .x+XcзģKKYŕFߚRv+z1qEMZxk"Gd,(MG2˛DyD2ua,s@\S૮uH &~ X* ݵ1mϘ~'Fs&$^"UW:̈KFIҜBfTe@S%Rt`ch`[lߧë 2J5LJMcmS@GJdo%2Mt#LZ xjltb:׉ɭ1dC?Xal'C8Q/gm qGtA}IVCcFclĥ mCj`o- iXw8ZK4-p8'\)U͕6(I䅝q[>FD4+hSCP=/=nk䨕T]͢ޒT- z+Td^opA$].lQK/}8(c[$Z^-샥3^ 8F'KtMIG92 can0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 cleartomark endstream endobj 150 0 obj<> endobj 34 0 obj<> endobj 151 0 obj <>stream  cvt bfpgmIglyf headg "6hheao"$hmtxłc#locaBmaxp b prep~ϚbcxdYV`jv^gakwL}g# CCw|}44 \wCXLkr/:FRb3AJMjiH\shhSn +j1 bLz fYY-`#)kkcyfVfZc/M\AyoV@@TH:<;:9876543210/.-,+*)('&%$#"!  ,CX+!!!Y-,CX+!!!Y-,CX%!!!!Y-,CX+!!!Y-,CX+!!!Y-,CX+!!!Y-,CX+!!!Y-,NF#CD%F!M-,CXEdj#EiCd``F#D# F/!!!!Y-, C#Ce -, C#C -,F#pF>F#pFE: -,+%E%Ej@`%#D!!!-,+%E%Ej`%#D!!!-,+!!!-,+!!!-,CCe -, i@a ,b`+ d#da\XaY-,%EhTX%E%E`h %#D%#D% Eh #D%Eh`%#DY-,% Eh #D%Eh`%#D-, CX!CXE+G#DGzEi G#D QX+G#DGz!GzYYY-, E#Eh`D-,EjB-,/-,!!-,%E%Ed`j%Eja %Ej e%#D%#D!!-,Eh#Eia%Eja %Ej e%#D%#D!!-,Ed#EdadB-,%C@T%CTZX% E@aDY%CT%C@TZX% E@`DY!!!!-,KRXC%E#aD!!Y-,KRXC%E#`D!!Y-,KRXED!!Y-, %#I@` c RX#%8#%e8c8!!!!!Y-,KPXED!!Y-,%# `#-,%# a#-,%-,F#F`F# F`ab# #KKpE` PXaFY`h:-, E%FRX?!Y-, E%FPX?!Y-,CC -,KRX%%I%%Ia TX! CUXY@TX CTXY CTX%8YYYY!!!!-,KRXCe8!!Y-,KRXC8!!Y-,!! d#d@b-,!QX d#d b@/+Y`-,!QX d#dUb/+Y`-, d#d@b`#!-,&&&&Eh:-,&&&&Ehe:-,CXY-,CXY-, +# <+-,(+# #+X59O4v" % A6O;*0Ș}-.$ ]G-#) C@/44 4CC CSVf B @  qn22????10]4&#"326%#"&'!!6632mfj/]-#G#}fT|F^Mi: &(8BR4*e@)$!;3!DO KE'* 7@ 7@7@ $@ 7$$@ $@ 7$$,p+3/+3?3/+?3/+10++]"&'&&54676632#&&'&&#"32676673UT^fWT{]^-=$&`;Bd$#2-O)3YFIIݖIFC+/0- " 6#C@-; ;L Lp#* 7* 7A!B o% p$22????10++]!!5#"4676632!&&#"326"W!*R9LC=aXqK^T~eq.^u@> PIU%'"' $4%g@#% 4 AOA S$sz* 7%< ">7@ 7@  q''% p&2]3/?3/++]?9/10+] ! !32676673&&#"<8.-xG=v1+I%+G>9yadfs0H~Ni,otziTY@<@ ?  0 @  /  /]3/]/2/9/]??32?2/10#&&#"!!!#5354632TU&jML0 Nk o 6Y9p@Q<K@C$pyzp6)* 7 7* 7* 79A4 B+ 0p!A 7(o;@.p:3/]22?3/]???10++++]&&#"326#"&'332676655#"46766327!%L&~Q?/[ZNNڅpJ)G$+R+Yw;RIA>_V8 Sb Ie'&' Ü=>7  %"#_H4?"JGM,%29@$4 E p D o`  n2]??D?C?B?A?@??5233554455@!5 6@q::6q@q 6ppo@o6n@n 6pfff@g 6ed@;d 6@ ?_  k@khhhPh`ha0[@[[[8@ 6@@ +*p*,--  C! C <$e2"H/ 0@PpP`p0/?o /?o 7 7 **& 9999PKKTBKKSB 2+KdRBKRXYKTXYKSXY++++++++st+ststEEha#DsEEha#DsEEha#DEh#Dst++tu++++u+++++++++s+++++++++ss++sssstssssss+ss+s+u+us+u++s+++++++++++++++++++++++++++ss+s+sss++s+s++s+++++ss+++s+++s+++++ts+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ endstream endobj 152 0 obj<> endobj 153 0 obj<>/Subtype/CIDFontType2/Type/Font/W [3[292]29[363]38[667]44[483]46[696]50[770]53[726 633 612]68[598 631 527 629 593 382 629 640 301 362]79[301 953 640 617 629]85[433 514 415 640]90[889 604 575]]/CIDToGIDMap/Identity/DW 1000>> endobj 154 0 obj <>stream /CIDInit /ProcSet findresource begin 12 dict begin begincmap /CIDSystemInfo << /Registry (Adobe) /Ordering (UCS) /Supplement 0 >> def /CMapName /Adobe-Identity-UCS def /CMapType 2 def 1 begincodespacerange <0003><005c> endcodespacerange 31 beginbfrange <0003><0003><0020> <001d><001d><003a> <0026><0026><0043> <002c><002c><0049> <002e><002e><004b> <0032><0032><004f> <0035><0035><0052> <0036><0036><0053> <0037><0037><0054> <0044><0044><0061> <0045><0045><0062> <0046><0046><0063> <0047><0047><0064> <0048><0048><0065> <0049><0049><0066> <004a><004a><0067> <004b><004b><0068> <004c><004c><0069> <004d><004d><006a> <004f><004f><006c> <0050><0050><006d> <0051><0051><006e> <0052><0052><006f> <0053><0053><0070> <0055><0055><0072> <0056><0056><0073> <0057><0057><0074> <0058><0058><0075> <005a><005a><0077> <005b><005b><0078> <005c><005c><0079> endbfrange endcmap CMapName currentdict /CMap defineresource pop end end endstream endobj 3 0 obj<> endobj 155 0 obj <>stream %!PS-AdobeFont-1.0: ArialMT Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: Thu Oct 09 15:49:19 2008 % Converted from TrueType font 'ARIAL.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 2.76) readonly def /Notice (Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved) readonly def /FullName (Arial) readonly def /FamilyName (Arial) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -106 def /UnderlineThickness 73 def end readonly def /FontName /ArialMT def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {-46 -210 1000 896} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /quotedbl put dup 35 /numbersign put dup 36 /dollar put dup 37 /percent put dup 38 /ampersand put dup 39 /quotesingle put dup 40 /parenleft put dup 41 /parenright put dup 42 /asterisk put dup 43 /plus put dup 44 /comma put dup 45 /hyphen put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /at put dup 65 /A put dup 66 /B put dup 67 /C put dup 68 /D put dup 69 /E put dup 70 /F put dup 71 /G put dup 72 /H put dup 73 /I put dup 74 /J put dup 75 /K put dup 76 /L put dup 77 /M put dup 78 /N put dup 79 /O put dup 80 /P put dup 81 /Q put dup 82 /R put dup 83 /S put dup 84 /T put dup 85 /U put dup 86 /V put dup 87 /W put dup 88 /X put dup 89 /Y put dup 90 /Z put dup 91 /bracketleft put dup 92 /backslash put dup 93 /bracketright put dup 94 /asciicircum put dup 95 /underscore put dup 96 /grave put dup 97 /a put dup 98 /b put dup 99 /c put dup 100 /d put dup 101 /e put dup 102 /f put dup 103 /g put dup 104 /h put dup 105 /i put dup 106 /j put dup 107 /k put dup 108 /l put dup 109 /m put dup 110 /n put dup 111 /o put dup 112 /p put dup 113 /q put dup 114 /r put dup 115 /s put dup 116 /t put dup 117 /u put dup 118 /v put dup 119 /w put dup 120 /x put dup 121 /y put dup 122 /z put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /asciitilde put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /quotesinglbase put dup 131 /florin put dup 132 /quotedblbase put dup 133 /ellipsis put dup 134 /dagger put dup 135 /daggerdbl put dup 136 /circumflex put dup 137 /perthousand put dup 138 /Scaron put dup 139 /guilsinglleft put dup 140 /OE put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /quoteleft put dup 146 /quoteright put dup 147 /quotedblleft put dup 148 /quotedblright put dup 149 /bullet put dup 150 /endash put dup 151 /emdash put dup 152 /tilde put dup 153 /trademark put dup 154 /scaron put dup 155 /guilsinglright put dup 156 /oe put dup 157 /.notdef put dup 158 /.notdef put dup 159 /Ydieresis put dup 160 /space put dup 161 /exclamdown put dup 162 /cent put dup 163 /sterling put dup 164 /currency put dup 165 /yen put dup 166 /brokenbar put dup 167 /section put dup 168 /dieresis put dup 169 /copyright put dup 170 /ordfeminine put dup 171 /guillemotleft put dup 172 /logicalnot put dup 173 /hyphen put dup 174 /registered put dup 175 /overscore put dup 176 /degree put dup 177 /plusminus put dup 178 /twosuperior put dup 179 /threesuperior put dup 180 /acute put dup 181 /mu1 put dup 182 /paragraph put dup 183 /periodcentered put dup 184 /cedilla put dup 185 /onesuperior put dup 186 /ordmasculine put dup 187 /guillemotright put dup 188 /onequarter put dup 189 /onehalf put dup 190 /threequarters put dup 191 /questiondown put dup 192 /Agrave put dup 193 /Aacute put dup 194 /Acircumflex put dup 195 /Atilde put dup 196 /Adieresis put dup 197 /Aring put dup 198 /AE put dup 199 /Ccedilla put dup 200 /Egrave put dup 201 /Eacute put dup 202 /Ecircumflex put dup 203 /Edieresis put dup 204 /Igrave put dup 205 /Iacute put dup 206 /Icircumflex put dup 207 /Idieresis put dup 208 /Eth put dup 209 /Ntilde put dup 210 /Ograve put dup 211 /Oacute put dup 212 /Ocircumflex put dup 213 /Otilde put dup 214 /Odieresis put dup 215 /multiply put dup 216 /Oslash put dup 217 /Ugrave put dup 218 /Uacute put dup 219 /Ucircumflex put dup 220 /Udieresis put dup 221 /Yacute put dup 222 /Thorn put dup 223 /germandbls put dup 224 /agrave put dup 225 /aacute put dup 226 /acircumflex put dup 227 /atilde put dup 228 /adieresis put dup 229 /aring put dup 230 /ae put dup 231 /ccedilla put dup 232 /egrave put dup 233 /eacute put dup 234 /ecircumflex put dup 235 /edieresis put dup 236 /igrave put dup 237 /iacute put dup 238 /icircumflex put dup 239 /idieresis put dup 240 /eth put dup 241 /ntilde put dup 242 /ograve put dup 243 /oacute put dup 244 /ocircumflex put dup 245 /otilde put dup 246 /odieresis put dup 247 /divide put dup 248 /oslash put dup 249 /ugrave put dup 250 /uacute put dup 251 /ucircumflex put dup 252 /udieresis put dup 253 /yacute put dup 254 /thorn put dup 255 /ydieresis put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B T13҂uGFsnA S1_ z.H@sV-umQ/ rgrVFcSctóinuk̾uA M[\b y9_ )(ib]o7PaZk=JI4wr QeR-ӐhX}Qt 1ݫja@K^ }= j"D3XU:*u?| 6&f]'(VY k?YODn7Or>TɩZfZvZ7N-N}.^1>dL,͝0n8^|0~ZPFP^̵x} Tj9th ?H2wr=\aK&cE"*X8)nXZI- Rҿ mRdokh_`V#wp; նגdRyf,jL%>lzr{,V\d6koXp a~( q;(I9zF<2(u4Z+(9%%W# )3Z+B gmMJۿ;5t2&M}wP-B*' lC7AEÐ-XaTu:RD/ ~Xmv@JO"Ⲕ!d #\8_A#~#aMzNNZ2>ieec5+#TMg]Ⴤ]p9jqe^alǣ̏:Ϯ6~O(SW™^tpTeͦVzĻ[ 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!k@^B\Xi\M'}lb7zȋ_xU-$y/'gv+i;0J~]Z*e}O<\jry싯Gf#٩sdJŢʨ'{x@W,ک! pն_ ep׼!c&uLA{`\ 9Ia.c4 <6Z%^66853y̌{0rf\F3O<Յb4 2 0Uj~em&A$؜P_kqaM}x]|#&m.}?{- { ٔbDBw'n|Our 7=xKs_H./bɞob#p{Xkc*b yꍋQB_u}~?ށ8i<ֳ,#Rlw>g钑yLu$]UþCi Rhr+9aa9wuA&DKw^Qe|Z 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 cleartomark endstream endobj 156 0 obj<> endobj 35 0 obj<> endobj 157 0 obj <>stream  cvt gxfpgm;_glyfˬ ^head< H6hhea$ $hmtx ploca76maxp 1t prepF 8}11c1bbDu1c111D1>}1(111{-1(3c1J`7]1bP2Jb2(11124bb(()_b{8P>2;IV`bbz!&BF7>>TtNmmn{{(hxAYiU\.t/J\cx{{{ ""(/23>CFHPSfijkrsx,.88AMP\ik| ,,Alx=>o:BX~9`/111:<JJLWstx  ((-WYZZZZprr."+`x =.:WX]]SlCcM*SclAq],C]"D>;KeJPBQLQLT7Z\WU:rrE@78743210/.-,+*)('&%$#"!  ,E#F` &`&#HH-,E#F#a &a&#HH-,E#F` a F`&#HH-,E#F#a ` &a a&#HH-,E#F`@a f`&#HH-,E#F#a@` &a@a&#HH-, <<-, E# D# ZQX# D#Y QX# MD#Y &QX# D#Y!!-, EhD ` EFvhE`D-, C#Ce -, C#C -,F#pF>F#pFE: -,EJ#DEI#D-, E%EadPQXED!!Y-,Cc#b#B+-, EC`D-,CCe -, i@a ,b`+ d#da\XaY-,E+G#DGz-,TX CTXJIDDYY-,CXE+#DzEi #D QX+#Dz!zYY-,-,KRX!ED#E %ERXD!!YY-,/-, %EI#DEJ#DEe#E %`j #B#hj`a Ry!J@JE TX#!?#YaDRyI@ IE TX#!?#YaD-,C#C -,C#C -, C#C -, C#Ce -,C#Ce -,C#Ce -,KRXED!!Y-, %#I@` c RX#%8#%e8c8!!!!!Y-,Ei C`:-,%# `#-,%# a#-,%-, ` <<-, a <<-,++**-,CC -,>**-,5-,vK#p KE PXaY:/-,!! d#d@b-,!QX d#d b@/+Y`-,!QX d#dUb/+Y`-, d#d@b`#!-,&&&&Eh:-,&&&&Ehe:-,E# E %PX&a&`YD-,F#F`F# F`ab# #KKpE` PXa@Yh:-,3+**-,CXY-,CXY-#@/?103!%!!8 P@+  { /999?999/10&''&&'632!!!!67`,9) KgJ*JJ&J (""" """ zJzJee") """"!!""+ ]+PV =`9PPPP""""""""""""""""""""""kk4!!!!!!!!!!!!o!!!!!!!o!!!!!!!!!po==!!!!!!!!!!!!!!!!!!b!Q!?!.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!}!&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&`9_@ FF@H H2 %H2 #H2 "H2 !H2  H2 H2 H2 H2 @[H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 yH2 nH2 dH2 _H2 ]H2 ZH2 XH2 H2 H2 H2 H2 H2 H2 H2 @LH2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 H2 \H2& & 7E@CzweaWU$"   KKSBKcKb S# QZ#BKKTB8+TXCXYY++++++++++++++++++++++++++++++++KPyAP*&+++++KSyAP*&+++++P2Ka`+++++++++++++++++++++++++++++++++++++++++++++++++++++++++EiSBKPXBYC\XBY CX`!YBp>CX;!~ +Y #B #BCX-A-A +Y#B#BCX~;! +Y#B#B endstream endobj 158 0 obj<> endobj 159 0 obj<>/Subtype/CIDFontType2/Type/Font/W [53[891]133[891]]/CIDToGIDMap/Identity/DW 1000>> endobj 160 0 obj <>stream /CIDInit /ProcSet findresource begin 12 dict begin begincmap /CIDSystemInfo << /Registry (Adobe) /Ordering (UCS) /Supplement 0 >> def /CMapName /Adobe-Identity-UCS def /CMapType 2 def 1 begincodespacerange <0035><0085> endcodespacerange 2 beginbfrange <0035><0035><0052> <0085><0085><00a3> endbfrange endcmap CMapName currentdict /CMap defineresource pop end end endstream endobj 103 0 obj<> endobj 161 0 obj <>stream %!PS-AdobeFont-1.0: Verdana Typeface and data 1996 Microsoft Corporation. All Rights Reserved %%CreationDate: Thu Oct 09 15:25:10 2008 % Converted from TrueType font 'VERDANA.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 2.35) readonly def /Notice (Typeface and data 1996 Microsoft Corporation. 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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endobj 169 0 obj <>stream application/pdf 2009-07-17T10:01:59+01:00 2009-08-18T16:36:14+01:00 2009-08-18T16:36:14+01:00 iText 1.3.6 (by lowagie.com) distributed with the Software Developer's Journal uuid:6a36daf4-4a8e-4184-baa6-5dc06c6b1379 uuid:01c1964c-facc-472a-bdc4-1d063e134e07 endstream endobj 170 0 obj <>stream q 1 0 0 1 28.3500061 35.5599976 cm 0.753 0.753 0.753 RG 20.58 w 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 12 Tf 2 Tr 31.2 30.79 Td (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 446.48 1.01 Td (Page)Tj 2 Tr 30.53 0 Td (58)Tj 0 Tr ( of )Tj 2 Tr (61)Tj ET q 1 0 0 1 32.3200073 565.1300049 cm 0.953 0.953 0.953 RG 492.54 w 0 0 m 532.65 0 l S Q q 1 0 0 1 31.1999969 659.9900055 cm 1 1 1 RG 102 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 659.9900055 cm 1 1 1 RG 102 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 659.9900055 cm 1 1 1 RG 102 w 0 0 m 89.8 0 l S Q q 1 0 0 1 291.6999969 659.9900055 cm 1 1 1 RG 102 w 0 0 m 182.1 0 l S Q q 1 0 0 1 476.0500031 659.9900055 cm 1 1 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The registered person\(s\) must do this within the timescales\ we have set.)Tj /T1_0 10 Tf -2.85 -17.82 Td (No.)Tj 64.9 -3 Td (Standard)Tj 106.4 0 Td [(Regulation)-3880(Requirement)]TJ 276.5 0 Td (Timescale for )Tj 0 -12.15 TD (action)Tj /T1_0 12 Tf -183.2 -17.16 Td ( )Tj 0 -17 TD ( )Tj T* ( )Tj T* ( )Tj T* ( )Tj /C2_0 12 Tf -260.3 -21.5 Td <0003>Tj -4.55 -21.5 Td <0003>Tj /T1_0 12 Tf 1 0 0 1 35.174 590.18 Tm [(28)-4045(38)]TJ 166.05 0 Td (13)Tj /C2_0 12 Tf <0003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf (The home must set up a )Tj /C2_0 12 Tf <00030003000300030003000300030003001600130012001300190012001500130013001C>Tj -170.274 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 573.18 Tm (documentary system to )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 556.18 Tm (show that all shower heads )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 539.18 Tm (are regularly checked for )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 522.18 Tm [(lime-scale and any )1(lime-)]TJ /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 505.18 Tm [(scale)1( identified, removed.)]TJ /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 488.18 Tm (Shower heads in large )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 471.18 Tm (premises such as care )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 454.18 Tm (homes can harbour )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 437.18 Tm (Legionellum, which can be a )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 420.18 Tm (potentially very serious )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 403.18 Tm (illness, particularly if lime )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 386.18 Tm (scale is present. Therefore )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 369.18 Tm (there needs to be clear )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 352.18 Tm (records of the checking of )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 335.18 Tm (shower heads.)Tj -82.062 272 Td (\240)Tj ET q 1 0 0 1 32.3200073 186.5399933 cm 0.953 0.953 0.953 RG 221.65 w 0 0 m 532.65 0 l S Q q 1 0 0 1 31.1999969 192.0599976 cm 1 1 1 RG 35.16 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 192.0599976 cm 1 1 1 RG 35.16 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 192.0599976 cm 1 1 1 RG 35.16 w 0 0 m 366.45 0 l S Q q 1 0 0 1 31.1999969 161.9400024 cm 1 1 1 RG 20.58 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 161.9400024 cm 1 1 1 RG 20.58 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 161.9400024 cm 1 1 1 RG 20.58 w 0 0 m 366.45 0 l S Q q 1 0 0 1 31.1999969 131.8200073 cm 1 1 1 RG 35.16 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 131.8200073 cm 1 1 1 RG 35.16 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 131.8200073 cm 1 1 1 RG 35.16 w 0 0 m 366.45 0 l S Q q 1 0 0 1 31.1999969 94.4100037 cm 1 1 1 RG 35.16 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 94.4100037 cm 1 1 1 RG 35.16 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 94.4100037 cm 1 1 1 RG 35.16 w 0 0 m 366.45 0 l S Q q 1 0 0 1 28.9900055 173.3600006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 150.5299988 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 113.1199951 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 30.0700073 211.8500061 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -137.22 l S Q q 1 0 0 1 567.2200012 211.8500061 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -137.22 l S Q q 1 0 0 1 28.9900055 230.0399933 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 210.7700043 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 92.1699982 211.8500061 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -137.22 l S Q q 1 0 0 1 198.5200043 211.8500061 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -137.22 l S Q q 1 0 0 1 28.9900055 299.6100006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 230.0399933 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 173.3600006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 150.5299988 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 113.1199951 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 75.7100067 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 30.0700073 300.6900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -91 l S Q q 1 0 0 1 92.1699982 231.1199951 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -20.35 l S Q q 1 0 0 1 198.4700012 231.1199951 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -20.35 l S Q q 1 0 0 1 567.3200073 300.6900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -91 l S Q BT /T1_0 12 Tf 2 Tr 34.05 283.43 Td (Recommendations)Tj 0 Tr 0 -17.58 TD (These recommendations are taken from the best practice described in the \ National )Tj 0 -14.58 TD (Minimum Standards and the registered person\(s\) should consider them as\ a way of )Tj T* (improving their service.)Tj /T1_0 10 Tf 0 -20.82 TD [(No)-4855(Refer to Standard)-1673(Good Practice Recommendations)]TJ /T1_0 12 Tf 0 -21.29 TD [(1)-4539(8)]TJ 168.45 0 Td (The clinical indicator for the use of a urinary catheter )Tj 0 -14.58 TD (should always be documented.)Tj -168.45 -22.83 Td [(2)-4539(8)]TJ 168.45 0 Td (Fluid charts should be totalled every 24 hours.)Tj -168.45 -22.83 Td [(3)-4539(8)]TJ 168.45 0 Td (Wounds should be regularly photographed to assist in )Tj T* (assessment of response to interventions.)Tj -168.45 -22.83 Td [(4)-4539(8)]TJ 168.45 0 Td (Documentation relating to pressure ulceration should )Tj T* (include an assessment of the grade of the ulcer.)Tj ET endstream endobj 171 0 obj [172 0 R] endobj 172 0 obj <> endobj 173 0 obj <> endobj 174 0 obj <> endobj 175 0 obj <>stream 0.753 0.753 0.753 RG 20.58 w q 1 0 0 1 28.35 35.56 cm 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 12 Tf 2 Tr 31.2 30.79 Td (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 446.48 1.01 Td (Page)Tj 2 Tr 30.53 0 Td (57)Tj 0 Tr ( of )Tj 2 Tr (61)Tj ET 0.953 0.953 0.953 RG 746.25 w q 1 0 0 1 32.32 438.28 cm 0 0 m 532.65 0 l S Q 1 1 1 RG 408 w q 1 0 0 1 31.2 506.99 cm 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3 506.99 cm 0 0 m 104.1 0 l S Q q 1 0 0 1 199.65 506.99 cm 0 0 m 89.8 0 l S Q q 1 0 0 1 291.7 506.99 cm 0 0 m 182.1 0 l S Q q 1 0 0 1 476.05 506.99 cm 0 0 m 90.05 0 l S Q 236.71 w q 1 0 0 1 31.2 182.38 cm 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3 182.38 cm 0 0 m 104.1 0 l S Q q 1 0 0 1 199.65 182.38 cm 0 0 m 89.8 0 l S Q q 1 0 0 1 291.7 182.38 cm 0 0 m 182.1 0 l S Q q 1 0 0 1 476.05 182.38 cm 0 0 m 90.05 0 l S Q 0.753 0.753 0.753 RG 2.25 w q 1 0 0 1 28.99 301.86 cm 0 0 m 539.31 0 l S Q q 1 0 0 1 30.07 713.19 cm 0 0 m 0 -651.37 l S Q q 1 0 0 1 567.22 713.19 cm 0 0 m 0 -651.37 l S Q q 1 0 0 1 28.99 744.66 cm 0 0 m 539.41 0 l S Q q 1 0 0 1 28.99 712.11 cm 0 0 m 539.31 0 l S Q q 1 0 0 1 92.17 713.19 cm 0 0 m 0 -651.37 l S Q q 1 0 0 1 198.52 713.19 cm 0 0 m 0 -651.37 l S Q q 1 0 0 1 290.57 713.19 cm 0 0 m 0 -651.37 l S Q q 1 0 0 1 474.92 713.19 cm 0 0 m 0 -651.37 l S Q q 1 0 0 1 28.99 813.65 cm 0 0 m 539.41 0 l S Q q 1 0 0 1 28.99 744.66 cm 0 0 m 539.41 0 l S Q q 1 0 0 1 28.99 712.11 cm 0 0 m 539.41 0 l S Q q 1 0 0 1 28.99 301.86 cm 0 0 m 539.31 0 l S Q q 1 0 0 1 28.99 62.9 cm 0 0 m 539.31 0 l S Q q 1 0 0 1 30.07 814.73 cm 0 0 m 0 -103.69 l S Q q 1 0 0 1 92.12 745.74 cm 0 0 m 0 -34.7 l S Q q 1 0 0 1 198.52 745.74 cm 0 0 m 0 -34.7 l S Q q 1 0 0 1 290.62 745.74 cm 0 0 m 0 -34.7 l S Q q 1 0 0 1 475.02 745.74 cm 0 0 m 0 -34.7 l S Q q 1 0 0 1 567.32 814.73 cm 0 0 m 0 -103.69 l S Q BT 0 0 0 RG 0.5 w /T1_0 12 Tf 31.2 800.47 Td (Statutory requirements)Tj 0 Tr 2.85 -20 Td (These requirements set out what the registered person must do to meet th\ e Care )Tj 0 -14.58 TD [(Standards Act 2000, Care Homes)-351(Regulations 2001 and the National Minimum )]TJ T* (Standards. The registered person\(s\) must do this within the timescales\ we have set.)Tj /T1_0 10 Tf -2.85 -17.82 Td (No.)Tj 64.9 -3 Td (Standard)Tj 106.4 0 Td [(Regulation)-3880(Requirement)]TJ 276.5 0 Td (Timescale for )Tj 0 -12.15 TD (action)Tj /T1_0 12 Tf -443.5 -19.41 Td [(26)-4045(38)]TJ 166.05 0 Td (13)Tj 96.5 0 Td (Bed rails must always be )Tj 0 -17 TD (safely used in accordance )Tj T* (with national guidelines. )Tj T* (Care plans for their use )Tj T* (must be regularly and fully )Tj T* (evaluated. There must be a )Tj T* (documentary system for )Tj T* (regular checks on bed rails. )Tj T* (There must be evidence that )Tj T* (people who check bed rails )Tj T* (have been trained in their )Tj T* (role.)Tj T* (\240)Tj T* (There is a large body of )Tj T* (evidence about the risks to )Tj T* (people from the use of bed )Tj T* (rails, therefore they must )Tj T* (only be used if it can be )Tj T* (demonstrated that their use )Tj T* (is in the best interest of the )Tj T* (person and that all required )Tj T* (safety checks have been )Tj T* (performed by a person who )Tj T* (is qualified to do so. )Tj 184.05 391 Td (30/06/2009\240)Tj -184.05 -17 Td (\240)Tj T* ( )Tj T* ( )Tj T* ( )Tj T* ( )Tj T* ( )Tj 184.05 204 Td (\240)Tj ET endstream endobj 176 0 obj <>stream 0.753 0.753 0.753 RG 20.58 w q 1 0 0 1 28.35 56.81 cm 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 11 Tf 2 Tr 31.2 53.04 Td (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 425.26 -1 Td (\240)Tj /T1_0 11 Tf 21.22 1 Td (Page )Tj 2 Tr (42)Tj 0 Tr ( of )Tj 2 Tr (61)Tj /T1_1 10 Tf 0 Tr -449.33 -15.43 Td (\240)Tj ET 0.996 0.945 0.761 RG 728.25 w q 1 0 0 1 34.6 447.28 cm 0 0 m 527.94 0 l S Q 1 1 1 RG 22.5 w q 1 0 0 1 32.35 802.41 cm 0 0 m 532.44 0 l S Q 706.88 w q 1 0 0 1 33.47 435.47 cm 0 0 m 530.19 0 l S Q 0.753 0.753 0.753 RG 2.25 w q 1 0 0 1 31.27 790.03 cm 0 0 m 534.6 0 l S Q q 1 0 0 1 32.35 791.11 cm 0 0 m 0 -711.29 l S Q q 1 0 0 1 564.79 791.11 cm 0 0 m 0 -711.29 l S Q q 1 0 0 1 32.35 790.03 cm 0 0 m 532.44 0 l S Q q 1 0 0 1 31.27 80.9 cm 0 0 m 534.6 0 l S Q BT /T1_0 12 Tf 35.5 799.09 Td (Evidence:)Tj -1.18 -17.5 Td ( )Tj 0 -17.5 TD (During the inspection, we observed several staff manoevering wheelchairs\ by lifting )Tj 0 -17.49 TD (them by their rear handles. This is regarded as unsafe practice in manua\ l handling. )Tj 0 -17.5 TD (Just before lunch, we observed two care staff bring a resident into the \ sitting room. )Tj 0 -17.49 TD (They put their arms under the person's shoulders to lift them up. Then, \ apparently )Tj 0 -17.5 TD (after noticing us, tried to encourage the resident to stand themselves, \ but the resident )Tj T* (was not able to do so, so transferring the resident to their armchair wa\ s complex, both )Tj 0 -17.49 TD (for staff and the resident. We reviewed this resident's care plan, which\ stated that )Tj 0 -17.5 TD (they must always be transferred using a lifting belt, which the staff ha\ d not done. As )Tj 0 -17.49 TD (noted in Staffing above, not all staff have received mandatory manual ha\ ndling )Tj 0 -17.5 TD (training, so this may be a factor in what we observed. The home must tak\ e action by )Tj T* (training and staff supervision to ensure that staff comply in full with \ care plans and )Tj 0 -17.49 TD (perform safe manual handling practice at all times.)Tj 0 -17.5 TD (\240)Tj 0 -17.49 TD (As noted in Environment above, we noted a range of practices which indic\ ated )Tj 0 -17.5 TD (developments are needed to ensure risk of infection is fully reduced. A \ review 25 )Tj T* (records did indicate that 20 staff had recently been trained in the area\ but )Tj 0 -17.49 TD (observations indicate that quality of training and closer supervision of\ staff practice is )Tj 0 -17.5 TD (needed.)Tj 0 -17.49 TD (\240)Tj 0 -17.5 TD (We observed that staff consistently used foot plates on wheelchairs when\ moving )Tj T* (residents about the home. We asked about monthly checks on wheelchairs a\ nd were )Tj 0 -17.49 TD (advised that this had been delegated to a specific carer. People we spok\ e with were )Tj 0 -17.5 TD (not sure if records were kept of these checks. As there is a body of evi\ dence to )Tj 0 -17.49 TD (indicate that people can be put at risk by wheelchairs which are not reg\ ularly checked )Tj 0 -17.5 TD (and serviced. There need to be full records of checks made and actions t\ aken to )Tj T* (address any deficits.)Tj 0 -17.49 TD (\240)Tj 0 -17.5 TD (At the last inspection, the home were recommended to review their bed ra\ il records )Tj 0 -17.49 TD (and up-date them in line with national guidelines. During the inspection\ , we observed )Tj 0 -17.5 TD (that several residents who spent all or most of their time had safety ra\ ils in place. All )Tj T* (of the safety rails in the four different rooms that we inspected were l\ oose in their )Tj ET endstream endobj 177 0 obj <>stream 0.753 0.753 0.753 RG 20.58 w q 1 0 0 1 28.35 56.81 cm 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 11 Tf 2 Tr 31.2 53.04 Td (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 425.26 -1 Td (\240)Tj /T1_0 11 Tf 21.22 1 Td (Page )Tj 2 Tr (41)Tj 0 Tr ( of )Tj 2 Tr (61)Tj /T1_1 10 Tf 0 Tr -449.33 -15.43 Td (\240)Tj ET 0.996 0.945 0.761 RG 728.25 w q 1 0 0 1 34.6 447.28 cm 0 0 m 527.94 0 l S Q 1 1 1 RG 22.5 w q 1 0 0 1 32.35 802.41 cm 0 0 m 532.44 0 l S Q 706.88 w q 1 0 0 1 33.47 435.47 cm 0 0 m 530.19 0 l S Q 0.753 0.753 0.753 RG 2.25 w q 1 0 0 1 31.27 790.03 cm 0 0 m 534.6 0 l S Q q 1 0 0 1 32.35 791.11 cm 0 0 m 0 -711.29 l S Q q 1 0 0 1 564.79 791.11 cm 0 0 m 0 -711.29 l S Q q 1 0 0 1 32.35 790.03 cm 0 0 m 532.44 0 l S Q q 1 0 0 1 31.27 80.9 cm 0 0 m 534.6 0 l S Q BT /T1_0 12 Tf 35.5 799.09 Td (Evidence:)Tj -1.18 -19.99 Td (within timescales, if they continued to be un-met at the next inspection\ , we would be )Tj 0 -17.5 TD (taking action within our procedures to ensure that they were addressed.)Tj 0 -17.49 TD (\240)Tj 0 -17.5 TD (We discussed other management arrangements and concerns which had arisen\ from )Tj T* (this inspection. We informed her that as pressure ulceration is a matter\ that can )Tj 0 -17.49 TD (adversely affect a residents' well-being, under our legislation, we need\ to be informed )Tj 0 -17.5 TD (of every instance, in accordance with our notification processes. A regi\ stered nurse we )Tj 0 -17.49 TD (spoke with was not aware of the notification process to us for the medic\ ation error )Tj 0 -17.5 TD (which was identified at this inspection, and that as the manager may not\ be on duty at )Tj T* (all times, people who may be in charge of the home need training in thei\ r )Tj 0 -17.49 TD (management responsibilities in this area.)Tj 0 -17.5 TD (\240)Tj 0 -17.49 TD (The home has an administrator, who includes management of residents' own\ finances )Tj 0 -17.5 TD (within their role. The home offers choice to residents, they will look a\ fter residents' )Tj T* (moneys or the resident or family can do this. Where a resident wishes to\ look after )Tj 0 -17.49 TD (their own moneys, the home offers the resident a lockable cash box. If t\ he home looks )Tj 0 -17.5 TD (after residents' moneys, this is held in individual bank accounts. The h\ ome has a clear )Tj 0 -17.49 TD (system for managing residents' finances, with a full audit trail from in\ voices for )Tj 0 -17.5 TD (services such as the hairdressing, chiropody or newspapers, to the resid\ ent's own )Tj T* (account. The administrator reported that they perform an audit three mon\ thly and )Tj 0 -17.49 TD (perform a reconciliation, which is double checked. Where cheques or cash\ are handed )Tj 0 -17.5 TD (in by relatives at evenings or the weekend, there is a secure cupboard, \ to which the )Tj 0 -17.49 TD (registered nurse in charge of the home has access, and receipts are give\ n.)Tj 0 -17.5 TD (\240)Tj T* (At the previous inspection, the home were required to devise and impleme\ nt an )Tj 0 -17.49 TD (effective quality assurance system. The administrator reported that they\ have sent out )Tj 0 -17.5 TD (questionnaires to residents and their supporters, that four had been ret\ urned so far )Tj 0 -17.49 TD (and that when more had been returned, she would collate the responses. A\ s noted in )Tj 0 -17.5 TD (health and personal care above, the home have commenced an audit of mana\ gement )Tj T* (of medicines, however due to the issues identified at this inspection, i\ t has clearly not )Tj 0 -17.49 TD (been implemented in full. They also report in their AQAA that they are r\ eviewing care )Tj 0 -17.5 TD (plans, but this inspection indicates that more action is needed in this \ area. The home )Tj 0 -17.49 TD (have provided us with a full and detailed annual quality assessment, how\ ever )Tj 0 -17.5 TD (evidence from this inspection indicates that some parts of the assessmen\ t has not )Tj T* (properly considered a range of issues relating to service provision.)Tj 0 -17.49 TD (\240)Tj /C2_0 12 Tf 0 -17.49 Td <003A0048000300440056004E0048004700030049005200550003005500480046005200550047005600030052004900030046004B00480046004E005600030052005100030056004B0052005A004800550003004B0048004400470056000F00030045005800570003004C005700030044005300530048004400550048004700030057004B0044005700030057004B0048005500480003005A0048005500480003005100520003>Tj 0 -17.49 TD <0055004800460052005500470056000300550048004F00440057004C0051004A00030057005200030057004B004C0056001100030036004B0052005A004800550003004B004800440047005600030051004800480047000300570052000300450048000300550048004A0058004F00440055004F005C00030046004B00480046004E00480047000300490052005500030057004B00480003005300550048005600480051004600480003>Tj 0 -17.49 TD <005200490003004F004C005000480003005600460044004F004800030044005100470003004C0049000300470048005300520056004C0057005600030044005500480003004C0047004800510057004C0049004C00480047000F00030057004B00480003005000580056005700030045004800030055004800500052005900480047000F000300570052000300550048004700580046004800030055004C0056004E0003005200490003>Tj 0 -17.49 TD <002F0048004A004C005200510048004F004F0058005000110003>Tj ET endstream endobj 178 0 obj <>stream 0.753 0.753 0.753 RG 20.58 w q 1 0 0 1 28.35 56.81 cm 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 11 Tf 2 Tr 31.2 53.04 Td (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 425.26 -1 Td (\240)Tj /T1_0 11 Tf 21.22 1 Td (Page )Tj 2 Tr (37)Tj 0 Tr ( of )Tj 2 Tr (61)Tj /T1_1 10 Tf 0 Tr -449.33 -15.43 Td (\240)Tj ET 0.996 0.945 0.761 RG 728.25 w q 1 0 0 1 34.6 447.28 cm 0 0 m 527.94 0 l S Q 1 1 1 RG 22.5 w q 1 0 0 1 32.35 802.41 cm 0 0 m 532.44 0 l S Q 706.88 w q 1 0 0 1 33.47 435.47 cm 0 0 m 530.19 0 l S Q 0.753 0.753 0.753 RG 2.25 w q 1 0 0 1 31.27 790.03 cm 0 0 m 534.6 0 l S Q q 1 0 0 1 32.35 791.11 cm 0 0 m 0 -711.29 l S Q q 1 0 0 1 564.79 791.11 cm 0 0 m 0 -711.29 l S Q q 1 0 0 1 32.35 790.03 cm 0 0 m 532.44 0 l S Q q 1 0 0 1 31.27 80.9 cm 0 0 m 534.6 0 l S Q BT /T1_0 12 Tf 35.5 799.09 Td (Evidence:)Tj -1.18 -19.99 Td (they monitored response times when the call bell was used and she report\ ed that they )Tj 0 -17.5 TD (did not. In their AQAA, the home reported that they were planning to ful\ ly up-grade )Tj 0 -17.49 TD (and modernise the call bell system.)Tj 0 -17.5 TD (\240)Tj T* (At the last inspection, it was required that staff records must contain \ evidence that all )Tj 0 -17.49 TD (required recruitment checks have been completed for all employees. In th\ eir AQAA, )Tj 0 -17.5 TD (the home commented "staff commence employment only after the home has re\ ceived )Tj 0 -17.49 TD (suitable references, a record of employment history and POVA clearance".\ During the )Tj 0 -17.5 TD (inspection, we looked at five files of staff who had recently commenced \ employment. )Tj T* (We found that )Tj /C2_0 12 Tf <005200510048>Tj /T1_0 12 Tf ( person had )Tj /C2_0 12 Tf <005800510048005B0053004F0044004C0051004800470003004A0044005300560003004C005100030057004B0048004C00550003004800500053004F0052005C00500048005100570003004B004C0056005700520055005C000F0003005A004B004C0046004B>Tj /T1_0 12 Tf 0 -17.49 Td (there was no evidence had been )Tj /C2_0 12 Tf <005300550052004500480047000300440051004700030057005A00520003005600570044004900490003004B0044004700030051005200030053004B005200570052004A005500440053004B0056000300520055000300520057004B00480055>Tj /T1_0 12 Tf T* (proof of identity. This is of concern, )Tj /C2_0 12 Tf <0044005600030057004B004C005600030050004400570057004800550003005A004400560003004C0047004800510057004C0049004C004800470003004400560003004400030055004800540058004C0055004800500048005100570003004400570003>Tj /T1_0 12 Tf 0 -17.49 TD (the previous inspection. Residents )Tj /C2_0 12 Tf 1 0 0 1 245.484 569.15 Tm <00500044005C000300510052005700030045004800030056004400490048004A0058004400550047004800470003004C004900030044004F004F000300550048004600550058004C005700500048005100570003>Tj -211.164 -17.5 Td <005300550052004600480056005600480056000F0003>Tj /T1_0 12 Tf (which have been set out for their protection, have not been complied wit\ h.)Tj 0 -17.49 TD (\240)Tj 0 -17.5 TD (One person had commenced work after their pova clearance had been obtain\ ed but )Tj 0 -17.49 TD (before their CRB clearance had been returned. Our legislation states tha\ t staff may )Tj 0 -17.5 TD (commence work after pova clearance has been returned, but they must work\ fully )Tj T* (supervised until CRB clearance is received. There was no written evidenc\ e that this )Tj 0 -17.49 TD (was taking place. Staff we spoke to did report that a new member of staf\ f was )Tj 0 -17.5 TD (allocated to a mentor, however that due to the staff rotas, the person w\ ould not )Tj 0 -17.49 TD (always be on duty at the same time as their mentor and they were not awa\ re of any )Tj 0 -17.5 TD (additional supervison systems, until CRB clearance was obtained.)Tj T* (\240)Tj 0 -17.49 TD (When staff commence work, they are given an induction. The home has an i\ nduction )Tj 0 -17.5 TD (checklist and the training manager reported that on the new member of st\ aff's first )Tj 0 -17.49 TD (day, they go through the check-list with them, reporting that generally \ this takes two )Tj 0 -17.5 TD (to three hours. The check-list is extensive, covering a range of areas. \ A registered )Tj T* (nurse reported on the induction, that the new member of staff was traine\ d by the )Tj 0 -17.49 TD (trainer, then allocated to a senior carer as mentor. The new member of s\ taff would )Tj 0 -17.5 TD (observe at first, then become more hands on, as they become more confide\ nt. A new )Tj 0 -17.49 TD (member of staff would not work on own their own until assessed as able t\ o do so. )Tj 0 -17.5 TD (About four weeks after the person had commenced employment, the training\ manager )Tj T* (will see the new member of staff again and ask them to give a feedback, \ including )Tj 0 -17.49 TD (assessing their understanding of safeguarding. Three members of staff ar\ e qualified )Tj 0 -17.5 TD (manual handling trainers and they will induct the new person in this are\ a. Two to )Tj 0 -17.49 TD (three hours may not be sufficient to cover all areas on induction, howev\ er too much )Tj 0 -17.5 TD (information at one time may not be beneficial to learning. Many homes br\ eak down )Tj T* (their induction programme, so that areas are covered in a structured man\ ner, over )Tj ET endstream endobj 179 0 obj <>stream 0.753 0.753 0.753 RG 20.58 w q 1 0 0 1 28.35 56.81 cm 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 11 Tf 2 Tr 31.2 53.04 Td (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 425.26 -1 Td (\240)Tj /T1_0 11 Tf 21.22 1 Td (Page )Tj 2 Tr (29)Tj 0 Tr ( of )Tj 2 Tr (61)Tj /T1_1 10 Tf 0 Tr -449.33 -15.43 Td (\240)Tj ET 0.996 0.945 0.761 RG 178.84 w q 1 0 0 1 34.6 721.99 cm 0 0 m 527.94 0 l S Q 1 1 1 RG 22.5 w q 1 0 0 1 32.35 802.41 cm 0 0 m 532.44 0 l S Q 157.46 w q 1 0 0 1 33.47 710.18 cm 0 0 m 530.19 0 l S Q 0.753 0.753 0.753 RG 2.25 w q 1 0 0 1 31.27 790.03 cm 0 0 m 534.6 0 l S Q q 1 0 0 1 32.35 791.11 cm 0 0 m 0 -161.87 l S Q q 1 0 0 1 564.79 791.11 cm 0 0 m 0 -161.87 l S Q q 1 0 0 1 32.35 790.03 cm 0 0 m 532.44 0 l S Q q 1 0 0 1 31.27 630.32 cm 0 0 m 534.6 0 l S Q BT /T1_0 12 Tf 35.5 799.09 Td (Evidence:)Tj /C2_0 12 Tf -1.18 -19.99 Td <0003>Tj /T1_0 12 Tf 0 -19.99 TD (The )Tj /C2_0 12 Tf 1 0 0 1 60.684 759.11 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 64.908 759.11 Tm (section )Tj /C2_0 12 Tf 1 0 0 1 111.684 759.11 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 115.908 759.11 Tm (on )Tj /C2_0 12 Tf 1 0 0 1 135.012 759.11 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 139.236 759.11 Tm (Staffing )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (below )Tj /C2_0 12 Tf 1 0 0 1 233.88 759.11 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 238.104 759.11 Tm (indicates )Tj /C2_0 12 Tf 1 0 0 1 295.572 759.11 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 299.796 759.11 Tm (that )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (the)Tj /C2_0 12 Tf 1 0 0 1 351.984 759.11 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 356.208 759.11 Tm ( home )Tj /C2_0 12 Tf <00030046005200510057004C005100580048005600030003005100520057000300030057005200030003004800510056005800550048>Tj /T1_0 12 Tf -321.888 -17.5 Td (that )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (it )Tj /C2_0 12 Tf <00030058>Tj /T1_0 12 Tf (ses )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (safe)Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf ( practice)Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf ( in)Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf ( the)Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf ( recruitment )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (of )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (staff, )Tj /C2_0 12 Tf <00030053004400550057004C00460058004F00440055004F005C0003004C00510003>Tj /T1_0 12 Tf 0 -17.49 TD (providing )Tj /C2_0 12 Tf 1 0 0 1 94.656 724.12 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 98.88 724.12 Tm (evidence )Tj /C2_0 12 Tf 1 0 0 1 156.276 724.12 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 160.5 724.12 Tm (that )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (staff )Tj /C2_0 12 Tf 1 0 0 1 224.076 724.12 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 228.3 724.12 Tm (work)Tj /C2_0 12 Tf 1 0 0 1 257.628 724.12 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 261.852 724.12 Tm ( fully )Tj /C2_0 12 Tf 1 0 0 1 295.8 724.12 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 300.024 724.12 Tm (supervised)Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf ( after)Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf ( their )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (protection )Tj -265.704 -17.5 Td (of vulnerable adults \(pova\) check has been returned and before their c\ riminal records )Tj 0 -17.5 TD (board \(CRB\) check has been returned. This also has the potential to pu\ t vulnerable )Tj 0 -17.49 TD (people at risk. As shown in Management and Administration below, the hom\ e are not )Tj 0 -17.5 TD (using safe practice in the use of bed safety rails, which could put resi\ dents at risk. )Tj ET endstream endobj 180 0 obj <>stream 0.753 0.753 0.753 RG 20.58 w q 1 0 0 1 28.35 56.81 cm 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 11 Tf 2 Tr 31.2 53.04 Td (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 425.26 -1 Td (\240)Tj /T1_0 11 Tf 21.22 1 Td (Page )Tj 2 Tr (28)Tj 0 Tr ( of )Tj 2 Tr (61)Tj /T1_1 10 Tf 0 Tr -449.33 -15.43 Td (\240)Tj ET 0.996 0.945 0.761 RG 728.25 w q 1 0 0 1 34.6 447.28 cm 0 0 m 527.94 0 l S Q 1 1 1 RG 22.5 w q 1 0 0 1 32.35 802.41 cm 0 0 m 532.44 0 l S Q 706.88 w q 1 0 0 1 33.47 435.47 cm 0 0 m 530.19 0 l S Q 0.753 0.753 0.753 RG 2.25 w q 1 0 0 1 31.27 790.03 cm 0 0 m 534.6 0 l S Q q 1 0 0 1 32.35 791.11 cm 0 0 m 0 -711.29 l S Q q 1 0 0 1 564.79 791.11 cm 0 0 m 0 -711.29 l S Q q 1 0 0 1 32.35 790.03 cm 0 0 m 532.44 0 l S Q q 1 0 0 1 31.27 80.9 cm 0 0 m 534.6 0 l S Q BT /T1_0 12 Tf 35.5 799.09 Td (Evidence:)Tj -1.18 -19.99 Td (In their AQAA, the home reported "complaints are recorded and followed u\ p )Tj 0 -17.5 TD (meticulously. Concerns are documented separately with action and outcome\ recorded. )Tj 0 -17.49 TD (Residents and those close to them are encouraged to bring all concerns t\ o the nurses )Tj 0 -17.5 TD (or manager to ensure that something is done about them immediately". We \ asked to )Tj T* (look at both these documents reported on in the home's AQAA. Discussions\ with the )Tj 0 -17.49 TD (manager indicated that the home had had no complaints in the past twelve\ months )Tj 0 -17.5 TD (and so the complaints book had not been used. However discussions with t\ he )Tj 0 -17.49 TD (administrator indicated that they had started dealing with a matter and \ had then )Tj 0 -17.5 TD (passed it on to the manager for further action. On discussion, the manag\ er reported )Tj T* (that they knew about this matter and that it was on her computer file. W\ e met with a )Tj 0 -17.49 TD (resident who raised a particular area of concern which they reported the\ y had raised )Tj 0 -17.5 TD (several times. Discussions with a range of staff indicated that they wer\ e aware of )Tj 0 -17.49 TD (these concerns, however contrary to the statement in the home's AQAA, no\ record )Tj 0 -17.5 TD (had been made of these concerns. During the inspection, two residents al\ so reported )Tj T* (on two other matters of concerns to them, they were of the impression th\ at they had )Tj 0 -17.49 TD (mentioned these matters to staff, but there appeared to have been no rec\ ords made )Tj 0 -17.5 TD (of these matters.)Tj 0 -17.49 TD (\240)Tj 0 -17.5 TD (The home needs to improve and develop its approach towards complaints an\ d )Tj T* (concerns. Many managers regard receipt and review of complaints and conc\ erns as a )Tj 0 -17.49 TD (key area in their quality audit, to show them how the service affects di\ fferent people.)Tj 0 -17.5 TD (\240)Tj 0 -17.49 TD (In their AQAA, the home stated that "each employee is trained in the pro\ tection of )Tj 0 -17.5 TD (vulnerable adults". During the inspection, we discussed training in abus\ e awareness )Tj T* (with the training manager, they reported that this is done using a DVD, \ followed by )Tj 0 -17.49 TD (discussions and a short test. We discussed training with a range of staf\ f. The chef )Tj 0 -17.5 TD (reported that they and all their staff had attended training in the prot\ ection of )Tj 0 -17.49 TD (vulnerable adults. We discussed the matter with the person performing la\ undry who )Tj 0 -17.5 TD (did not think that they had received such training. We looked at staff t\ raining records )Tj T* (and of the 25 we looked at only four showed that the member of staff had\ been )Tj 0 -17.49 TD (trained in safeguarding adults during the past year. We discussed awaren\ ess of this )Tj 0 -17.5 TD (key area with people and while some of them, when given scenarios, were \ fully aware )Tj 0 -17.49 TD (of actions to take, others, including a registered nurse, who may be in \ charge of the )Tj 0 -17.5 TD (home, was not aware of appropriate actions to take to safeguard vulnerab\ le people in )Tj T* (accordance with local procedures.)Tj 0 -17.49 TD (\240)Tj 0 -17.5 TD (As noted in Health and Personal Care above, the home has a higher than w\ ould be )Tj 0 -17.49 TD (anticipated number of people who have sustained pressure damage in the h\ ome. This )Tj 0 -17.5 TD (is of concern in relation to )Tj /C2_0 12 Tf <0053005500520057004800460057004C0051004A00030053004800520053004F0048000300490055005200500003004B00440055005000110003>Tj /T1_0 12 Tf ( )Tj ET endstream endobj xref 0 1 0000000000 65535 f 70 1 0000594711 00000 n 72 1 0000594873 00000 n 89 1 0000595035 00000 n 98 1 0000595197 00000 n 100 1 0000595359 00000 n 132 1 0000595509 00000 n 134 1 0000595648 00000 n 166 15 0000595800 00000 n 0000595880 00000 n 0000596112 00000 n 0000596219 00000 n 0000600088 00000 n 0000612783 00000 n 0000612810 00000 n 0000615782 00000 n 0000615852 00000 n 0000616076 00000 n 0000619450 00000 n 0000623057 00000 n 0000628297 00000 n 0000633541 00000 n 0000636926 00000 n trailer <]/Prev 591195>> startxref 641424 %%EOF 70 0 obj <>/ProcSet[/PDF/Text]>>/Type/Page>> endobj 72 0 obj <>/ProcSet[/PDF/Text]>>/Type/Page>> endobj 100 0 obj <>/ProcSet[/PDF/Text]>>/Type/Page>> endobj 102 0 obj <>/ProcSet[/PDF/Text]>>/Type/Page>> endobj 132 0 obj <>/ProcSet[/PDF/Text]>>/Type/Page>> endobj 134 0 obj <>/ProcSet[/PDF/Text]>>/Type/Page>> endobj 167 0 obj <> endobj 169 0 obj <>stream application/pdf 2009-07-17T10:01:59+01:00 2009-08-19T09:04:25+01:00 2009-08-19T09:04:25+01:00 iText 1.3.6 (by lowagie.com) distributed with the Software Developer's Journal uuid:6a36daf4-4a8e-4184-baa6-5dc06c6b1379 uuid:b8183c8c-7f2d-4cc4-a767-2124e9e6154e endstream endobj 181 0 obj <>stream q 1 0 0 1 28.3500061 35.5599976 cm 0.753 0.753 0.753 RG 20.58 w 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 12 Tf 2 Tr 31.2 30.79 Td (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 446.48 1.01 Td (Page)Tj 2 Tr 30.53 0 Td (58)Tj 0 Tr ( of )Tj 2 Tr (61)Tj ET q 1 0 0 1 32.3200073 565.1300049 cm 0.953 0.953 0.953 RG 492.54 w 0 0 m 532.65 0 l S Q q 1 0 0 1 31.1999969 659.9900055 cm 1 1 1 RG 102 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 659.9900055 cm 1 1 1 RG 102 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 659.9900055 cm 1 1 1 RG 102 w 0 0 m 89.8 0 l S Q q 1 0 0 1 291.6999969 659.9900055 cm 1 1 1 RG 102 w 0 0 m 182.1 0 l S Q q 1 0 0 1 476.0500031 659.9900055 cm 1 1 1 RG 102 w 0 0 m 90.05 0 l S Q q 1 0 0 1 31.1999969 462.2400055 cm 1 1 1 RG 289 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 462.2400055 cm 1 1 1 RG 289 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 462.2400055 cm 1 1 1 RG 289 w 0 0 m 89.8 0 l S Q q 1 0 0 1 291.6999969 462.2400055 cm 1 1 1 RG 289 w 0 0 m 182.1 0 l S Q q 1 0 0 1 476.0500031 462.2400055 cm 1 1 1 RG 289 w 0 0 m 90.05 0 l S Q q 1 0 0 1 28.9900055 607.8600006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 30.0700073 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -397.65 l S Q q 1 0 0 1 567.2200012 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -397.65 l S Q q 1 0 0 1 28.9900055 744.6600037 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 712.1100006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 92.1699982 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -397.65 l S Q q 1 0 0 1 198.5200043 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -397.65 l S Q q 1 0 0 1 290.5700073 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -397.65 l S Q q 1 0 0 1 474.9199982 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -397.65 l S Q q 1 0 0 1 28.9900055 813.6499939 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 744.6600037 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 712.1100006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 607.8600006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 316.6100006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 30.0700073 814.7299957 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -103.69 l S Q q 1 0 0 1 92.1199951 745.7400055 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -34.7 l S Q q 1 0 0 1 198.5200043 745.7400055 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -34.7 l S Q q 1 0 0 1 290.6199951 745.7400055 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -34.7 l S Q q 1 0 0 1 475.0200043 745.7400055 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -34.7 l S Q q 1 0 0 1 567.3200073 814.7299957 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -103.69 l S Q BT /T1_0 12 Tf 31.2 800.47 Td (Statutory requirements)Tj 0 Tr 2.85 -20 Td (These requirements set out what the registered person must do to meet th\ e Care )Tj 0 -14.58 TD [(Standards Act 2000, Care Homes)-351(Regulations 2001 and the National Minimum )]TJ T* (Standards. The registered person\(s\) must do this within the timescales\ we have set.)Tj /T1_0 10 Tf -2.85 -17.82 Td (No.)Tj 64.9 -3 Td (Standard)Tj 106.4 0 Td [(Regulation)-3880(Requirement)]TJ 276.5 0 Td (Timescale for )Tj 0 -12.15 TD (action)Tj /T1_0 12 Tf -183.2 -17.16 Td ( )Tj 0 -17 TD ( )Tj T* ( )Tj T* ( )Tj T* ( )Tj /C2_0 12 Tf -260.3 -21.5 Td <0003>Tj -4.55 -21.5 Td <00030015001B>Tj /T1_0 12 Tf 68.028 0 Td (38)Tj 102.246 0 Td (13)Tj /C2_0 12 Tf 1 0 0 1 35.174 590.18 Tm 181.314 0 Td <0003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf (The home must set up a )Tj /C2_0 12 Tf <00030003000300030003000300030003001600130012001300190012001500130013001C>Tj -185.538 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 573.18 Tm (documentary system to )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 556.18 Tm (show that all shower heads )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 539.18 Tm (are regularly checked for )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 522.18 Tm [(lime-scale and any )1(lime-)]TJ /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 505.18 Tm [(scale)1( identified, removed.)]TJ /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 488.18 Tm (Shower heads in large )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 471.18 Tm (premises such as care )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 454.18 Tm (homes can harbour )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 437.18 Tm (Legionellum, which can be a )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 420.18 Tm (potentially very serious )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 403.18 Tm (illness, particularly if lime )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 386.18 Tm (scale is present. Therefore )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 369.18 Tm (there needs to be clear )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 352.18 Tm (records of the checking of )Tj /C2_0 12 Tf -266.112 -17 Td <000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003000300030003>Tj /T1_0 12 Tf 1 0 0 1 297.062 335.18 Tm (shower heads.)Tj -82.062 272 Td (\240)Tj ET q 1 0 0 1 32.3200073 186.5399933 cm 0.953 0.953 0.953 RG 221.65 w 0 0 m 532.65 0 l S Q q 1 0 0 1 31.1999969 192.0599976 cm 1 1 1 RG 35.16 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 192.0599976 cm 1 1 1 RG 35.16 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 192.0599976 cm 1 1 1 RG 35.16 w 0 0 m 366.45 0 l S Q q 1 0 0 1 31.1999969 161.9400024 cm 1 1 1 RG 20.58 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 161.9400024 cm 1 1 1 RG 20.58 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 161.9400024 cm 1 1 1 RG 20.58 w 0 0 m 366.45 0 l S Q q 1 0 0 1 31.1999969 131.8200073 cm 1 1 1 RG 35.16 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 131.8200073 cm 1 1 1 RG 35.16 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 131.8200073 cm 1 1 1 RG 35.16 w 0 0 m 366.45 0 l S Q q 1 0 0 1 31.1999969 94.4100037 cm 1 1 1 RG 35.16 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 94.4100037 cm 1 1 1 RG 35.16 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 94.4100037 cm 1 1 1 RG 35.16 w 0 0 m 366.45 0 l S Q q 1 0 0 1 28.9900055 173.3600006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 150.5299988 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 113.1199951 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 30.0700073 211.8500061 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -137.22 l S Q q 1 0 0 1 567.2200012 211.8500061 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -137.22 l S Q q 1 0 0 1 28.9900055 230.0399933 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 210.7700043 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 92.1699982 211.8500061 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -137.22 l S Q q 1 0 0 1 198.5200043 211.8500061 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -137.22 l S Q q 1 0 0 1 28.9900055 299.6100006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 230.0399933 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 173.3600006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 150.5299988 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 113.1199951 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 75.7100067 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 30.0700073 300.6900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -91 l S Q q 1 0 0 1 92.1699982 231.1199951 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -20.35 l S Q q 1 0 0 1 198.4700012 231.1199951 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -20.35 l S Q q 1 0 0 1 567.3200073 300.6900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -91 l S Q BT /T1_0 12 Tf 2 Tr 34.05 283.43 Td (Recommendations)Tj 0 Tr 0 -17.58 TD (These recommendations are taken from the best practice described in the \ National )Tj 0 -14.58 TD (Minimum Standards and the registered person\(s\) should consider them as\ a way of )Tj T* (improving their service.)Tj /T1_0 10 Tf 0 -20.82 TD [(No)-4855(Refer to Standard)-1673(Good Practice Recommendations)]TJ /T1_0 12 Tf 0 -21.29 TD [(1)-4539(8)]TJ 168.45 0 Td (The clinical indicator for the use of a urinary catheter )Tj 0 -14.58 TD (should always be documented.)Tj -168.45 -22.83 Td [(2)-4539(8)]TJ 168.45 0 Td (Fluid charts should be totalled every 24 hours.)Tj -168.45 -22.83 Td [(3)-4539(8)]TJ 168.45 0 Td (Wounds should be regularly photographed to assist in )Tj T* (assessment of response to interventions.)Tj -168.45 -22.83 Td [(4)-4539(8)]TJ 168.45 0 Td (Documentation relating to pressure ulceration should )Tj T* (include an assessment of the grade of the ulcer.)Tj ET endstream endobj 182 0 obj <>stream q 1 0 0 1 28.3500061 35.5599976 cm 0.753 0.753 0.753 RG 20.58 w 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 12 Tf 2 Tr 31.2 30.79 Td (Care Homes for Older People)Tj /T1_0 11 Tf 0 Tr 446.48 1.01 Td (Page)Tj 2 Tr 30.53 0 Td (57)Tj 0 Tr ( of )Tj 2 Tr (61)Tj ET q 1 0 0 1 32.3200073 438.2799988 cm 0.953 0.953 0.953 RG 746.25 w 0 0 m 532.65 0 l S Q q 1 0 0 1 31.1999969 506.9900055 cm 1 1 1 RG 408 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 506.9900055 cm 1 1 1 RG 408 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 506.9900055 cm 1 1 1 RG 408 w 0 0 m 89.8 0 l S Q q 1 0 0 1 291.6999969 506.9900055 cm 1 1 1 RG 408 w 0 0 m 182.1 0 l S Q q 1 0 0 1 476.0500031 506.9900055 cm 1 1 1 RG 408 w 0 0 m 90.05 0 l S Q q 1 0 0 1 31.1999969 182.3800049 cm 1 1 1 RG 236.71 w 0 0 m 59.85 0 l S Q q 1 0 0 1 93.3000031 182.3800049 cm 1 1 1 RG 236.71 w 0 0 m 104.1 0 l S Q q 1 0 0 1 199.6499939 182.3800049 cm 1 1 1 RG 236.71 w 0 0 m 89.8 0 l S Q q 1 0 0 1 291.6999969 182.3800049 cm 1 1 1 RG 236.71 w 0 0 m 182.1 0 l S Q q 1 0 0 1 476.0500031 182.3800049 cm 1 1 1 RG 236.71 w 0 0 m 90.05 0 l S Q q 1 0 0 1 28.9900055 301.8600006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 30.0700073 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -651.37 l S Q q 1 0 0 1 567.2200012 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -651.37 l S Q q 1 0 0 1 28.9900055 744.6600037 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 712.1100006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 92.1699982 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -651.37 l S Q q 1 0 0 1 198.5200043 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -651.37 l S Q q 1 0 0 1 290.5700073 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -651.37 l S Q q 1 0 0 1 474.9199982 713.1900024 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -651.37 l S Q q 1 0 0 1 28.9900055 813.6499939 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 744.6600037 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 712.1100006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.41 0 l S Q q 1 0 0 1 28.9900055 301.8600006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 28.9900055 62.8999939 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 539.31 0 l S Q q 1 0 0 1 30.0700073 814.7299957 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -103.69 l S Q q 1 0 0 1 92.1199951 745.7400055 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -34.7 l S Q q 1 0 0 1 198.5200043 745.7400055 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -34.7 l S Q q 1 0 0 1 290.6199951 745.7400055 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -34.7 l S Q q 1 0 0 1 475.0200043 745.7400055 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -34.7 l S Q q 1 0 0 1 567.3200073 814.7299957 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -103.69 l S Q BT /T1_0 12 Tf 31.2 800.47 Td (Statutory requirements)Tj 0 Tr 2.85 -20 Td (These requirements set out what the registered person must do to meet th\ e Care )Tj 0 -14.58 TD [(Standards Act 2000, Care Homes)-351(Regulations 2001 and the National Minimum )]TJ T* (Standards. The registered person\(s\) must do this within the timescales\ we have set.)Tj /T1_0 10 Tf -2.85 -17.82 Td (No.)Tj 64.9 -3 Td (Standard)Tj 106.4 0 Td [(Regulation)-3880(Requirement)]TJ 276.5 0 Td (Timescale for )Tj 0 -12.15 TD (action)Tj /T1_0 12 Tf -443.5 -19.41 Td [(26)-4045(38)]TJ 166.05 0 Td (13)Tj 96.5 0 Td (Bed rails must always be )Tj /C2_0 12 Tf <0003000300030003000300030003001600130012001300190012001500130013001C>Tj /T1_0 12 Tf 0 -17 TD (safely used in accordance )Tj T* (with national guidelines. )Tj T* (Care plans for their use )Tj T* (must be regularly and fully )Tj T* (evaluated. There must be a )Tj T* (documentary system for )Tj T* (regular checks on bed rails. )Tj T* (There must be evidence that )Tj T* (people who check bed rails )Tj T* (have been trained in their )Tj T* (role.)Tj T* (\240)Tj T* (There is a large body of )Tj T* (evidence about the risks to )Tj T* (people from the use of bed )Tj T* (rails, therefore they must )Tj T* (only be used if it can be )Tj T* (demonstrated that their use )Tj T* (is in the best interest of the )Tj T* (person and that all required )Tj T* (safety checks have been )Tj T* (performed by a person who )Tj T* (is qualified to do so. )Tj /C2_0 12 Tf -267.1 -17 Td <2000>Tj T* <2000>Tj /T1_0 12 Tf 184.05 391 Td (\240)Tj -184.05 -17 Td (\240)Tj T* ( )Tj T* ( )Tj T* ( )Tj T* ( )Tj T* ( )Tj 184.05 204 Td (\240)Tj ET endstream endobj 183 0 obj <>stream 0.753 0.753 0.753 RG 20.58 w q 1 0 0 1 28.35 56.81 cm 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 11 Tf 2 Tr 31.2 53.04 Td (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 425.26 -1 Td (\240)Tj /T1_0 11 Tf 21.22 1 Td (Page )Tj 2 Tr (43)Tj 0 Tr ( of )Tj 2 Tr (61)Tj /T1_1 10 Tf 0 Tr -449.33 -15.43 Td (\240)Tj ET 0.996 0.945 0.761 RG 511.26 w q 1 0 0 1 34.6 555.78 cm 0 0 m 527.94 0 l S Q 1 1 1 RG 22.5 w q 1 0 0 1 32.35 802.41 cm 0 0 m 532.44 0 l S Q 489.89 w q 1 0 0 1 33.47 543.96 cm 0 0 m 530.19 0 l S Q 0.753 0.753 0.753 RG 2.25 w q 1 0 0 1 31.27 790.03 cm 0 0 m 534.6 0 l S Q q 1 0 0 1 32.35 791.11 cm 0 0 m 0 -494.29 l S Q q 1 0 0 1 564.79 791.11 cm 0 0 m 0 -494.29 l S Q q 1 0 0 1 32.35 790.03 cm 0 0 m 532.44 0 l S Q q 1 0 0 1 31.27 297.89 cm 0 0 m 534.6 0 l S Q BT /T1_0 12 Tf 35.5 799.09 Td (Evidence:)Tj /C2_0 12 Tf -1.18 -17.5 Td <2000>Tj 0 -17.5 TD <004500480048005100030003>Tj /T1_0 12 Tf 1 0 0 1 72.144 764.09 Tm (delegated)Tj /C2_0 12 Tf 1 0 0 1 131.256 764.09 Tm <0003>Tj /T1_0 12 Tf 1 0 0 1 135.48 764.09 Tm ( to )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (a )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (care )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (assistant, )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (but )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (people )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (were)Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf ( not)Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf ( sure)Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf ( if )Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf (records)Tj /C2_0 12 Tf <0003>Tj /T1_0 12 Tf ( of )Tj -101.16 -17.5 Td (these checks were maintained. Bed rails have been associated with a high\ level of risk )Tj 0 -17.49 TD (to people and there is a large body of evidence to show that people have\ been )Tj 0 -17.5 TD (seriously harmed or worse by their unsafe or inappropriate use. Therefor\ e, they must )Tj 0 -17.49 TD (always be used safely and care plans relating to their sure be accurate \ and regularly )Tj 0 -17.5 TD (up-dated. Any person who checks bed-rails needs to be fully trained in t\ heir role.)Tj T* (\240)Tj 0 -17.49 TD (We reviewed the home's accident records. An audit of accidents takes pla\ ce, but the )Tj 0 -17.5 TD (audit does not include time of day or day of the week, to assess if acci\ dent happened )Tj 0 -17.49 TD (more at certain time of the day or certain days of the week, such as wee\ kends. We )Tj 0 -17.5 TD (observed several reports of "found on floor", which did not state which \ side the person )Tj T* (was found in or any equipment/furniture involved. It is advisable for ac\ cident records )Tj 0 -17.49 TD (to detail all factors involved in a fall. These was also no evidence tha\ t accidents to )Tj 0 -17.5 TD (residents were reviewed at 24 and 48 hours, which is regarded as good pr\ actice, as )Tj 0 -17.49 TD (some injuries to elderly people may not be evidence until some time afte\ r the event.)Tj 0 -17.5 TD (\240)Tj T* (We observed that one registered nurse had sustained a needle-stick injur\ y a few )Tj 0 -17.49 TD (weeks before the inspection. There was no evidence of follow-up relating\ to this injury )Tj 0 -17.5 TD (for the nurse. The Health and Safety Executive states that the employer \ must provide )Tj 0 -17.49 TD (effective and accessible services to staff in the event of a needle-stic\ k injury.)Tj ET endstream endobj 184 0 obj <>stream q 1 0 0 1 28.3500061 56.8099976 cm 0.753 0.753 0.753 RG 20.58 w 0 0 m 538.58 0 l S Q BT 0 0 0 rg 0 0 0 RG 0.5 w /T1_0 11 Tf 2 Tr 31.2 53.04 Td (Care Homes for Older People)Tj /T1_0 12 Tf 0 Tr 425.26 -1 Td (\240)Tj /T1_0 11 Tf 21.22 1 Td (Page )Tj 2 Tr (42)Tj 0 Tr ( of )Tj 2 Tr (61)Tj /T1_1 10 Tf 0 Tr -449.33 -15.43 Td (\240)Tj ET q 1 0 0 1 34.6000061 447.2799988 cm 0.996 0.945 0.761 RG 728.25 w 0 0 m 527.94 0 l S Q q 1 0 0 1 32.3500061 802.4100037 cm 1 1 1 RG 22.5 w 0 0 m 532.44 0 l S Q q 1 0 0 1 33.4700012 435.4700012 cm 1 1 1 RG 706.88 w 0 0 m 530.19 0 l S Q q 1 0 0 1 31.2700043 790.0299988 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 534.6 0 l S Q q 1 0 0 1 32.3500061 791.1100006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -711.29 l S Q q 1 0 0 1 564.7899933 791.1100006 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 0 -711.29 l S Q q 1 0 0 1 32.3500061 790.0299988 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 532.44 0 l S Q q 1 0 0 1 31.2700043 80.8999939 cm 0.753 0.753 0.753 RG 2.25 w 0 0 m 534.6 0 l S Q BT /T1_0 12 Tf 35.5 799.09 Td (Evidence:)Tj -1.18 -17.5 Td ( )Tj 0 -17.5 TD (During the inspection, we observed several staff manoevering wheelchairs\ by lifting )Tj 0 -17.49 TD (them by their rear handles. This is regarded as unsafe practice in manua\ l handling. )Tj 0 -17.5 TD (Just before lunch, we observed two care staff bring a resident into the \ sitting room. )Tj 0 -17.49 TD (They put their arms under the person's shoulders to lift them up. Then, \ apparently )Tj 0 -17.5 TD (after noticing us, tried to encourage the resident to stand themselves, \ but the resident )Tj T* (was not able to do so, so transferring the resident to their armchair wa\ s complex, both )Tj 0 -17.49 TD (for staff and the resident. We reviewed this resident's care plan, which\ stated that )Tj 0 -17.5 TD (they must always be transferred using a lifting belt, which the staff ha\ d not done. As )Tj 0 -17.49 TD (noted in Staffing above, not all staff have received mandatory manual ha\ ndling )Tj 0 -17.5 TD (training, so this may be a factor in what we observed. The home must tak\ e action by )Tj T* (training and staff supervision to ensure that staff comply in full with \ care plans and )Tj 0 -17.49 TD (perform safe manual handling practice at all times.)Tj 0 -17.5 TD (\240)Tj 0 -17.49 TD (As noted in Environment above, we noted a range of practices which indic\ ated )Tj 0 -17.5 TD (developments are needed to ensure risk of infection is fully reduced. A \ review 25 )Tj T* (records did indicate that 20 staff had recently been trained in the area\ but )Tj 0 -17.49 TD (observations indicate that quality of training and closer supervision of\ staff practice is )Tj 0 -17.5 TD (needed.)Tj 0 -17.49 TD (\240)Tj 0 -17.5 TD (We observed that staff consistently used foot plates on wheelchairs when\ moving )Tj T* (residents about the home. We asked about monthly checks on wheelchairs a\ nd were )Tj 0 -17.49 TD (advised that this had been delegated to a specific carer. People we spok\ e with were )Tj 0 -17.5 TD (not sure if records were kept of these checks. As there is a body of evi\ dence to )Tj 0 -17.49 TD (indicate that people can be put at risk by wheelchairs which are not reg\ ularly checked )Tj 0 -17.5 TD (and serviced. There need to be full records of checks made and actions t\ aken to )Tj T* (address any deficits.)Tj 0 -17.49 TD (\240)Tj 0 -17.5 TD (At the last inspection, the home were recommended to review their bed ra\ il records )Tj 0 -17.49 TD (and up-date them in line with national guidelines. During the inspection\ , we observed )Tj 0 -17.5 TD (that several residents who spent all or most of their time had safety ra\ ils in place. 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their AQAA, the home reported "complaints are recorded and followed u\ p )Tj 0 -17.5 TD (meticulously. Concerns are documented separately with action and outcome\ recorded. )Tj 0 -17.49 TD (Residents and those close to them are encouraged to bring all concerns t\ o the nurses )Tj 0 -17.5 TD (or manager to ensure that something is done about them immediately". We \ asked to )Tj T* (look at both these documents reported on in the home's AQAA. Discussions\ with the )Tj 0 -17.49 TD (manager indicated that the home had had no complaints in the past twelve\ months )Tj 0 -17.5 TD (and so the complaints book had not been used. However discussions with t\ he )Tj 0 -17.49 TD (administrator indicated that they had started dealing with a matter and \ had then )Tj 0 -17.5 TD (passed it on to the manager for further action. On discussion, the manag\ er reported )Tj T* (that they knew about this matter and that it was on her computer file. W\ e met with a )Tj 0 -17.49 TD (resident who raised a particular area of concern which they reported the\ y had raised )Tj 0 -17.5 TD (several times. Discussions with a range of staff indicated that they wer\ e aware of )Tj 0 -17.49 TD (these concerns, however contrary to the statement in the home's AQAA, no\ record )Tj 0 -17.5 TD (had been made of these concerns. During the inspection, two residents al\ so reported )Tj T* (on two other matters of concerns to them, they were of the impression th\ at they had )Tj 0 -17.49 TD (mentioned these matters to staff, but there appeared to have been no rec\ ords made )Tj 0 -17.5 TD (of these matters.)Tj 0 -17.49 TD (\240)Tj 0 -17.5 TD (The home needs to improve and develop its approach towards complaints an\ d )Tj T* (concerns. Many managers regard receipt and review of complaints and conc\ erns as a )Tj 0 -17.49 TD (key area in their quality audit, to show them how the service affects di\ fferent people.)Tj 0 -17.5 TD (\240)Tj 0 -17.49 TD (In their AQAA, the home stated that "each employee is trained in the pro\ tection of )Tj 0 -17.5 TD (vulnerable adults". During the inspection, we discussed training in abus\ e awareness )Tj T* (with the training manager, they reported that this is done using a DVD, \ followed by )Tj 0 -17.49 TD (discussions and a short test. We discussed training with a range of staf\ f. The chef )Tj 0 -17.5 TD (reported that they and all their staff had attended training in the prot\ ection of )Tj 0 -17.49 TD (vulnerable adults. We discussed the matter with the person performing la\ undry who )Tj 0 -17.5 TD (did not think that they had received such training. We looked at staff t\ raining records )Tj T* (and of the 25 we looked at only four showed that the member of staff had\ been )Tj 0 -17.49 TD (trained in safeguarding adults during the past year. We discussed awaren\ ess of this )Tj 0 -17.5 TD (key area with people and while some of them, when given scenarios, were \ fully aware )Tj 0 -17.49 TD (of actions to take, others, including a registered nurse, who may be in \ charge of the )Tj 0 -17.5 TD (home, was not aware of appropriate actions to take to safeguard vulnerab\ le people in )Tj T* (accordance with local procedures.)Tj 0 -17.49 TD (\240)Tj 0 -17.5 TD (As noted in Health and Personal Care above, the home has a higher than w\ ould be )Tj 0 -17.49 TD (anticipated number of people who have sustained pressure damage in the h\ ome. 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