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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 (40)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 (40)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 (Ryland View)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 (Arnhem Way )Tj ET /F2 12 Tf BT 1 0 0 1 273.05 729.04 Tm (Great Bridge)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 711.46 Tm (West Midlands)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 693.88 Tm (DY4 7HR)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 (01215201577)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 (01215570859)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 34.05 602.56 Tm (Provider web address:)Tj ET /F2 12 Tf BT 1 0 0 1 273.05 602.56 Tm (www.bupa.com)Tj ET /F2 10 Tf BT 1 0 0 1 28.35 583.61 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 111.9 w 32.32 517.34 m 564.77 517.34 l S 0.001 w 1 1 1 RG 20.58 w 355.5 564.12 m 565.9 564.12 l S 0.001 w 20.58 w 31.2 518.46 m 565.9 518.46 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 31.2 495.63 m 353.25 495.63 l S 0.001 w 1 1 1 RG 20.58 w 355.5 495.63 m 565.9 495.63 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 31.2 472.8 m 353.25 472.8 l S 0.001 w 1 1 1 RG 20.58 w 355.5 472.8 m 565.9 472.8 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 552.71 m 568.1 552.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 529.88 m 567.8 529.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 507.05 m 568.1 507.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 354.37 576.61 m 354.37 551.63 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 484.22 m 568.1 484.22 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 28.99 552.71 m 567.8 552.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 529.88 m 568.1 529.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 507.05 m 568.1 507.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 484.22 m 568.1 484.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 461.39 m 568.1 461.39 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 576.61 m 30.07 460.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 354.37 508.12 m 354.37 460.31 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 576.61 m 567.02 460.31 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 (BUPA Care Homes \(CFHCare\) Ltd)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 536.52 Tm (Name of registered manager \(if applicable\))Tj ET /F2 12 Tf BT 1 0 0 1 34.05 513.69 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.05 490.86 Tm (Type of registration:)Tj ET /F2 12 Tf BT 1 0 0 1 358.35 490.86 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 468.03 Tm (Number of places registered:)Tj ET /F2 12 Tf BT 1 0 0 1 358.35 468.03 Tm (140)Tj ET /F2 10 Tf BT 1 0 0 1 28.35 449.09 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 28.35 432.09 Tm ()Tj ET 0.95294 0.95294 0.95294 RG 63.99 w 32.32 389.77 m 564.47 389.77 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 401.18 m 567.8 401.18 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 424.01 m 567.8 424.01 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 401.18 m 567.8 401.18 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 357.77 m 567.8 357.77 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 425.09 m 30.07 356.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 298.32 402.26 m 298.32 356.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.72 425.09 m 566.72 356.7 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 407.83 Tm (Conditions of registration:)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 385 Tm (Category\(ies\) :)Tj ET /F2 12 Tf BT 1 0 0 1 302.3 385 Tm (Number of places \(if applicable\):)Tj ET /F2 12 Tf BT 1 0 0 1 302.3 364.42 Tm (Under 65)Tj ET /F2 12 Tf BT 1 0 0 1 435.37 364.42 Tm (Over 65)Tj ET 1 1 1 RG 20.58 w 31.2 344.11 m 297.3 344.11 l S 0.001 w 20.58 w 299.55 344.11 m 431.45 344.11 l S 0.001 w 20.58 w 433.7 344.11 m 565.6 344.11 l S 0.001 w 35.16 w 31.2 313.99 m 297.3 313.99 l S 0.001 w 35.16 w 299.55 313.99 m 431.45 313.99 l S 0.001 w 35.16 w 433.7 313.99 m 565.6 313.99 l S 0.001 w 20.58 w 31.2 283.87 m 297.3 283.87 l S 0.001 w 20.58 w 299.55 283.87 m 431.45 283.87 l S 0.001 w 20.58 w 433.7 283.87 m 565.6 283.87 l S 0.001 w 20.58 w 31.2 261.04 m 297.3 261.04 l S 0.001 w 20.58 w 299.55 261.04 m 431.45 261.04 l S 0.001 w 20.58 w 433.7 261.04 m 565.6 261.04 l S 0.001 w 0.95294 0.95294 0.95294 RG 20.58 w 31.2 238.21 m 565.6 238.21 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 332.69 m 567.8 332.69 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 295.28 m 567.8 295.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 272.45 m 567.8 272.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 249.62 m 567.8 249.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 226.79 m 567.8 226.79 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 160.22 m 568.1 160.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 122.81 m 568.1 122.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 85.4 m 568.1 85.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 355.52 m 567.8 355.52 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 332.69 m 567.8 332.69 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 295.28 m 567.8 295.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 272.45 m 567.8 272.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 249.62 m 567.8 249.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 226.79 m 568.1 226.79 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 160.22 m 568.1 160.22 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 122.81 m 568.1 122.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 85.4 m 568.1 85.4 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 47.99 m 568.1 47.99 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 356.6 m 30.07 46.92 l S 0.001 w [] 0 d [] 0 d 2.25 w 298.42 356.6 m 298.42 248.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 432.57 356.6 m 432.57 248.54 l S 0.001 w [] 0 d [] 0 d 2.25 w 566.72 356.6 m 566.72 46.92 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 339.34 Tm (dementia)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 339.34 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 339.34 Tm (60)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 316.51 Tm (old age, not falling within any other )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 301.93 Tm (category)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 316.51 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 316.51 Tm (44)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 279.1 Tm (physical disability)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 279.1 Tm (26)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 279.1 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 256.27 Tm (terminally ill)Tj ET /F2 12 Tf BT 1 0 0 1 302.4 256.27 Tm (10)Tj ET /F2 12 Tf BT 1 0 0 1 436.55 256.27 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 233.44 Tm (Additional conditions: )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 210.61 Tm (One service user identified in the variation application of 29.11.04 may be )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 196.03 Tm (accommodated on Manby Unit who is 56 years and over. This will remain until such )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 181.45 Tm (time that the identified service users placement is terminated and whilst the home is )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 166.87 Tm (able to meet her needs.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 144.04 Tm (That 14 elderly \(OP\) service users and 10 service users with a terminal illness \(TI\) be )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 129.46 Tm (accommodated on Bloomfield Unit.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 106.63 Tm (That 26 physically disabled \(PD\) service users 18 years and over will be accommodated )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 92.05 Tm (on Palethorpe Unit)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 69.22 Tm (That 30 service users who are elderly and do not fall within any other category \(OP\) )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 54.64 Tm (who are 58 years and over will be accommodated on Haines Unit.)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 (40)Tj ET 0.8 0.8 0.8 RG 0.001 w 0 Tr [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 776.24 m 568.1 776.24 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 738.83 m 568.1 738.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 672.26 m 568.1 672.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 620.27 m 568.1 620.27 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 28.99 776.24 m 568.1 776.24 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 738.83 m 568.1 738.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 672.26 m 568.1 672.26 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 620.27 m 568.1 620.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 582.86 m 568.1 582.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 814.73 m 30.07 581.79 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 814.73 m 567.02 581.79 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 797.47 Tm (That 30 service users with dementia \(DE\)\(E\) 58 years and over will be accommodated )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 782.89 Tm (on Heronville Unit)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 760.06 Tm (That 30 service users with demetia \(DE\)\(E\) who are 58 years and over will be )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 745.48 Tm (accommodated on Manby Unit.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 722.65 Tm (That the variation granted on the 5 September 2005 for one male service user with )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 708.07 Tm (learning disabilities who is over 65 years and will be accommodated on Palethorpe )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 693.49 Tm (House, will only be for the lifetime of that identified service user and whilst the home is )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 678.91 Tm (able to meet his needs.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 656.08 Tm (The variation granted on the 31 May 2006 for one male service user who is 54 years )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 641.5 Tm (will only be for the lifetime of that identified service user and whilst the home is able to )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 626.92 Tm (meet his needs.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 604.09 Tm (There will be two registered nurses on duty at all times between 09.00 to 21.00 hours )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 589.51 Tm (on Bloomfield Unit)Tj ET 0.95294 0.95294 0.95294 RG 20.58 w 31.2 570.32 m 315.25 570.32 l S 0.001 w 1 1 1 RG 20.58 w 317.5 570.32 m 346.55 570.32 l S 0.001 w 20.58 w 348.8 570.32 m 377.9 570.32 l S 0.001 w 20.58 w 380.15 570.32 m 409.2 570.32 l S 0.001 w 20.58 w 411.45 570.32 m 440.55 570.32 l S 0.001 w 20.58 w 442.8 570.32 m 471.9 570.32 l S 0.001 w 20.58 w 474.15 570.32 m 503.2 570.32 l S 0.001 w 20.58 w 505.45 570.32 m 534.55 570.32 l S 0.001 w 20.58 w 536.8 570.32 m 565.9 570.32 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 581.74 m 568.1 581.74 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 558.91 m 568.1 558.91 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 582.82 m 30.07 557.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 316.37 582.82 m 316.37 557.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 347.67 582.82 m 347.67 557.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 379.02 582.82 m 379.02 557.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 410.32 582.82 m 410.32 557.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 441.67 582.82 m 441.67 557.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 473.02 582.82 m 473.02 557.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 504.32 582.82 m 504.32 557.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 535.67 582.82 m 535.67 557.83 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 582.82 m 567.02 557.83 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.05 565.55 Tm (Date of last inspection)Tj ET /F2 12 Tf BT 1 0 0 1 328.2 565.55 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 359.53 565.55 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 390.86 565.55 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 422.18 565.55 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 453.53 565.55 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 484.86 565.55 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 516.18 565.55 Tm (0)Tj ET /F2 12 Tf BT 1 0 0 1 547.53 565.55 Tm (8)Tj ET 0.95294 0.95294 0.95294 RG 17 w 31.2 545.91 m 565.9 545.91 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 536.28 m 568.1 536.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 537.36 m 30.07 260.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 537.36 m 567.02 260.96 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 555.53 m 568.1 555.53 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 536.28 m 568.1 536.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 262.03 m 568.1 262.03 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 556.61 m 30.07 535.21 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.02 556.61 m 567.02 535.21 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.5 542.35 Tm (Brief description of the )Tj ET /F2 12 Tf BT 1 0 0 1 177.31 542.35 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 523.1 Tm (Ryland View is a large nursing home owned by BUPA, with ample car parking in the )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 506.1 Tm (grounds. It is located near to Tipton and is accessible by car and public transport. Each )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 489.1 Tm (unit has it's own garden area. Care can be provided for up to 140 people in five )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 472.1 Tm (separate, purpose built and spacious bungalows, called Bloomfield, Haines, Manby, )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 455.1 Tm (Palethorpe and Heronville. Bloomfield can have up to 24 people, who are 58 years old )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 438.1 Tm (and above, 10 of whom may require palliative nursing care. Haines can have up to 30 )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 421.1 Tm (frail older people needing nursing care. Manby and Heronville can each have up to 30 )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 404.1 Tm (older people who have dementia. All bedrooms are single occupancy and there are 4 )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 387.1 Tm (en suite bedrooms on Bloomfield. There are toilet and bathroom facilities near to )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 370.1 Tm (bedrooms on other units. Each unit has a large communal lounge, dining room and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 353.1 Tm (small quiet lounge. Bloomfield and Palethorpe have an additional lounge. Bloomfield )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 336.1 Tm (has a large meeting room also used for teaching sessions. Each unit has a small )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 319.1 Tm (kitchenette, which can be used to make drinks and snacks. There are aids and )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 302.1 Tm (adaptations such as grab rails, assisted baths and hoists available on each unit. The )Tj ET /F2 12 Tf BT 1 0 0 1 35.5 285.1 Tm (administration offices, central laundry and kitchen are situated in a separate block.)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 268.1 Tm ()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 529/Matrix [1 0 0 1 0 0]>>stream xMo1+|KGJ%N qm*%rRiRމ=~^`kBq8qdQ=>`9 8[- 2K',)MP!BNquU J/G/.ZIźO$-,VZ[S{zle+ҴFiN EюL+R'I.5I:GC?ٟ\dSt@2M(hm-h] UeF>s C걳oT<#Ӳ"eW+LU6$ .vŶD T<s[E(]*3ŽZ.ٳJ|ݡnVtQ ]]i>|H׌t\ f|p|?> #k N&^#]3ř5v<[_)bEg-!4}344w6 N\( [i{_۹)`KkxuʹM?[#M 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 (40)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 (The last key inspection took place from 26 to 29 November 2008.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 240.9 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 226.32 Tm (We, the Care Quality Commission, \(CQC\), undertook an unannounced key inspection )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 211.74 Tm (visit. This meant that the home had not been given prior notice of the inspection visit. )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 197.15 Tm (Three inspectors spent a total of two weekdays at the home, accompanied for part of )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 182.57 Tm (the inspection by a CQC pharmacy inspector, who spent a day at the home. We )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 167.99 Tm (monitored the compliance with all Key National Minimum Standards at this visit. The )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 153.41 Tm (range of inspection methods to obtain evidence and make judgements included, )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 138.84 Tm (discussions with senior managers from BUPA, the registered manager, a new acting )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 124.25 Tm (manager, unit managers, and staff on duty during the visit. We spoke with people )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 109.68 Tm (living at the home and made discrete observations of people unable to talk to us. We )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 95.1 Tm (examined of a number of records. We also spoke to relatives visiting the home. This )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 80.51 Tm (home had lacked clear direction and stability for some time and received a poor, zero )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 65.93 Tm (star quality rating at the inspection in November 2008.)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 (40)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 192.54 w 32.32 716.26 m 566.72 716.26 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 30.12 618.86 m 568.92 618.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 814.73 m 31.2 617.79 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 814.73 m 567.85 617.79 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 32.92 802.72 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 788.14 Tm (Other information was gathered before this inspection visit including notification of )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 773.56 Tm (incidents, accidents and events submitted to the former CSCI.)Tj ET /F2 12 Tf BT 1 0 0 1 32.92 758.98 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 744.4 Tm (We looked around the premises, including the grounds, communal areas of the home, )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 729.82 Tm (the bathrooms, toilets, laundry, kitchen areas, and people's bedrooms, with their )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 715.24 Tm (permission, where possible.)Tj ET /F2 12 Tf BT 1 0 0 1 32.92 700.66 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 32.92 686.08 Tm (The range of fees for the service was published in the service user guides for each unit. )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 671.5 Tm (The weekly fees ranged between 470 to 1130, dependant on the assessed individual )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 656.92 Tm (needs of each person, and the type of room occupied. Items that are not covered by )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 642.34 Tm (the fee included toiletries, hairdressing, chiropody and newspapers. People are advised )Tj ET /F2 12 Tf BT 1 0 0 1 32.92 627.76 Tm (to contact the home for up to date information about the fees charged.)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 (40)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 428.82 w 32.32 559.41 m 566.72 559.41 l S 0.001 w 20.58 w 32.7 332.46 m 569.35 332.46 l S 0.001 w 255.9 w 33.82 191.98 m 568.22 191.98 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 30.12 343.88 m 568.92 343.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 776.03 m 31.2 342.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.2 343.88 m 569.35 343.88 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.7 321.05 m 569.35 321.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.62 321.05 m 570.42 321.05 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.62 62.9 m 570.42 62.9 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.7 322.13 m 32.7 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.85 776.03 m 567.85 342.8 l S 0.001 w [] 0 d [] 0 d 2.25 w 569.35 322.13 m 569.35 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 (The home was generally pleasant and we were told there was a refurbishment )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 744.18 Tm (programme due to take place. People generally told us they were happy there. There )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 729.6 Tm (was good access throughout the building with a range of aids and adaptations available )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 715.02 Tm (for dependent people.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 700.44 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 685.86 Tm (We saw that everyone, with the exception of people admitted to Bloomfield unit, had )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 671.28 Tm (an assessment of their needs before agreement was reached for them to come and live )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 656.7 Tm (at the home. This gave people reassurance the home could meet their needs.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 642.12 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 627.54 Tm (Relatives and people living at the home told us staff were caring, kind and helpful. )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 612.96 Tm (Comments included staff were "very helpful", "kind" and "wonderful".)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 598.38 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 583.8 Tm (Each of the units at Ryland View had its own activity therapist who worked with people )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 569.22 Tm (to help keep them engaged in their environment and hobbies and other interests. We )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 554.64 Tm (saw photos of some group outings and in house entertainment events. We also saw )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 540.06 Tm (people on Palethorpe unit helping in the garden.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 525.48 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 510.9 Tm (People generally told us that they liked the meals provided by the home and we saw )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 496.32 Tm (that there was plenty of choice available, especially on Haines unit.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 481.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 467.16 Tm (We saw and heard friendly banter between the members of staff and people living at )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 452.58 Tm (the home during the visit.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 438 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 423.42 Tm (The grounds and majority of individual garden areas were pleasant, with designated )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 408.84 Tm (disabled parking outside each unit, which benefited people living at the home and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 394.26 Tm (visitors to the home who may have disabilities.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 379.68 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 365.1 Tm (This inspection was conducted with full co-operation of the management, staff team )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 350.52 Tm (and people living at the home.)Tj ET /F2 10 Tf BT 1 0 0 1 568.97 557.86 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 330.35 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 32.7 327.69 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 1 569.35 330.91 Tm ()Tj ET /F2 10 Tf BT 1 0 0 1 31.2 190.43 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 304.86 Tm (Having looked all of the evidence from the previous inspection, we could see )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 290.28 Tm (improvements in all areas, although there was still some work to do with the end of life )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 275.7 Tm (planning for people. Where we identified areas for improvement in record keeping, the )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 261.12 Tm (staff we spoke to were able to tell us about the missing information. This appeared to )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 246.54 Tm (be an improvement since the last inspection.)Tj ET /F2 12 Tf BT 1 0 0 1 36.67 231.96 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 217.38 Tm (The organisation had implemented an improvement plan with more effective )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 202.8 Tm (monitoring systems in place. A new experienced acting manager had recently been )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 188.22 Tm (appointed and there was extensive senior managerial support to make sure )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 173.64 Tm (improvements required at the last inspection were developed and maintained. The staff )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 159.06 Tm (and people who had lived at the home for some time told us lots of things had )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 144.48 Tm (improved. An example was more staff on Bloomfield, allowing more time for each )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 129.9 Tm (person's care, though this was not demonstrated on Haines and Palethorpe units.)Tj ET /F2 12 Tf BT 1 0 0 1 36.67 115.32 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.67 100.74 Tm (There was improved access to activities, with activities organisers arranging in house )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 86.16 Tm (activities and outings. These have been expanded and individual activities planners put )Tj ET /F2 12 Tf BT 1 0 0 1 36.67 71.58 Tm (in place for each person, which generally relating to their preferred individual activities. )Tj ET /F2 10 Tf BT 1 0 0 1 570.47 190.43 Tm ()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 (40)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 382.08 w 33.82 621.49 m 568.22 621.49 l S 0.001 w 20.58 w 33.45 417.91 m 570.1 417.91 l S 0.001 w 341.34 w 34.57 234.7 m 568.97 234.7 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.62 813.65 m 570.42 813.65 l S 0.001 w [] 0 d [] 0 d 2.25 w 31.62 429.32 m 570.42 429.32 l S 0.001 w [] 0 d [] 0 d 2.25 w 569.35 814.73 m 569.35 428.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 406.49 m 570.1 406.49 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 429.32 m 570.1 429.32 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.37 406.49 m 571.17 406.49 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 32.7 814.73 m 32.7 428.25 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 407.57 m 33.45 61.82 l S 0.001 w [] 0 d [] 0 d 2.25 w 570.1 407.57 m 570.1 61.82 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 34.42 802.72 Tm (Social contact had also been improved for people being cared for in bed or in their )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 788.14 Tm (bedroom, with records kept to show refusals and any alternatives offered. Though this )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 773.56 Tm (is an area, which could improve further, for example we heard that some people were )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 758.98 Tm (bored at times.)Tj ET /F2 12 Tf BT 1 0 0 1 34.42 744.4 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.42 729.82 Tm (The organisation had improved they way complaints were handled and there were )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 715.24 Tm (improved records of investigations, outcomes and satisfaction levels. We made the )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 700.66 Tm (management aware of someone who spoke to us and remained dissatisfied. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 686.08 Tm (recommended that the home improved communication with this person. There were )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 671.5 Tm (improvements to the protection of vulnerable people at the home, with more proactive )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 656.92 Tm (safeguarding referrals made to the lead agency, Sandwell Safeguarding Manager and )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 642.34 Tm (appropriate notifications to the CQC without undue delays. This meant that vulnerable )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 627.76 Tm (people living at the home were now generally better protected from risks of harm.)Tj ET /F2 12 Tf BT 1 0 0 1 34.42 613.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.42 598.6 Tm (There were considerable improvements to the environment on Bloomfield and )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 584.02 Tm (Heronville, and 18 additional nursing profile beds, comfortable armchairs and other )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 569.44 Tm (furniture had been provided as part of a rolling programme of refurbishment.)Tj ET /F2 12 Tf BT 1 0 0 1 34.42 554.86 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.42 540.28 Tm (We noted improvements to the analysis and evaluation of accidents. This meant that )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 525.7 Tm (any trends or increased risks could be identified, and where possible be controlled and )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 511.12 Tm (minimised. There were other significant areas of health and safety and fire safety at )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 496.54 Tm (the home, which had been improved. These included safety checks for bedrails, fixed )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 481.96 Tm (wiring and emergency lighting had been satisfactorily concluded, and all staff, )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 467.38 Tm (especially night staff had received up to date fire training and participated in fire drills. )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 452.8 Tm (The other agencies such as the West Midland Fire Service and Health and Safety )Tj ET /F2 12 Tf BT 1 0 0 1 34.42 438.22 Tm (Executive were also satisfied with the level of compliance.)Tj ET /F2 10 Tf BT 1 0 0 1 31.2 416.36 Tm ()Tj ET /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 33.45 413.14 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 31.2 233.15 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 390.31 Tm (All of the people had care plans and risk assessments in place but the registered )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 375.73 Tm (persons need to make sure that all of the information is easily accessible for staff to )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 361.15 Tm (read. We looked at care files and found that people had care plans that were repetitive )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 346.57 Tm (and recorded on at least two plans. The staff should not be afraid to remove care plans )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 331.99 Tm (that were no longer relevant.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 317.41 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 302.83 Tm (We found evidence of some poor outcomes for people during this inspection, and there )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 288.25 Tm (must be further improvements to make sure that all needs are being met. Examples )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 273.67 Tm (were, one person was not receiving pain relief, there was no care plan for a person )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 259.09 Tm (with a catheter, and there should be more detail in the plans for someone needing )Tj ET /F2 12 Tf BT 1 0 0 1 541.22 259.09 Tm (one-)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 244.51 Tm (to-one)Tj ET /F2 12 Tf BT 1 0 0 1 76.91 244.51 Tm ( monitoring. Despite these shortfalls there were positive aspects in that the staff )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 229.93 Tm (on the units were aware of the people's needs. At the last inspection there were a )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 215.35 Tm (considerable number of areas of medication administration and recording, which we )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 200.77 Tm (required to be improved so that there was assurance that everyone living at the home )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 186.19 Tm (received their medicines as prescribed. Although there were improvements with the )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 171.61 Tm (way people's medication was being managed and administered, notably on Bloomfield, )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 157.03 Tm (there were repeated serious failures, notably on Manby and to a lesser extent on )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 142.45 Tm (Haines, where medication in the mornings was particularly protracted. There were also )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 127.87 Tm (medicines, which were not available. This meant that some people were not receiving )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 113.29 Tm (some of their medication as prescribed by their doctor at the right time.)Tj ET /F2 12 Tf BT 1 0 0 1 37.42 98.71 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 37.42 84.13 Tm (At the last inspection we received some comments, which indicated that soft diets and )Tj ET /F2 12 Tf BT 1 0 0 1 37.42 69.55 Tm (pureed diets were bland and repetitive and we recommended that improved meals )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 (40)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 1 1 1 RG 440.4 w 34.57 592.33 m 568.97 592.33 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 32.37 371 m 571.17 371 l S 0.001 w [] 0 d [] 0 d 2.25 w 33.45 814.73 m 33.45 369.93 l S 0.001 w [] 0 d [] 0 d 2.25 w 570.1 814.73 m 570.1 369.93 l S 0.001 w [] 0 d /F2 12 Tf BT 1 0 0 1 35.17 802.72 Tm (should be introduced. However the food we saw presented and we sampled for soft and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 788.14 Tm (pureed diets was unpleasant and unpalatable. The new chef gave assurances )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 773.56 Tm (improvements would be made. We will review the meals at the next inspection to test )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 758.98 Tm (out the validity of the assurances given.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 744.4 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 729.82 Tm (We were told that there was a planned refurbishment due to take place but we were )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 715.24 Tm (not given a timescale. A repair, renewal and maintenance plan had been put in place )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 700.66 Tm (since the last inspection but there were some areas of the home, which needed )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 686.08 Tm (prioritised attention. For example there were bathing and toilet facilities, with doors not )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 671.5 Tm (closing properly and unguarded radiators, which did not provide privacy and safety on )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 656.92 Tm (Palethorpe unit.)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 organisation had reviewed staffing levels on each unit, and whilst there were )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 613.18 Tm (improved levels of care and attention on some units, on others, such as Haines and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 598.6 Tm (Manby we were aware of people waiting unacceptable times to get up or be assisted )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 584.02 Tm (with meals and drinks. We discussed these concerns with the management, who )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 569.44 Tm (acknowledged them and gave assurances they would monitor the deployment and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 554.86 Tm (management of staff time on these units.)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 registered persons must also make the recruitment of new staff more rigorous, )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 511.12 Tm (exploring any anomalies in documents. Systems must be out in place to keep track of )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 496.54 Tm (expiry dates of overseas staff work permits and visas to allow them to remain and )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 481.96 Tm (work in the UK. The organisations must also implement systems to hold sufficient )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 467.38 Tm (information about agency staff to safeguard people living at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 35.17 452.8 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.17 438.22 Tm (We made the management of the home aware that a CQC management review would )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 423.64 Tm (be held to consider what further action might be needed to make sure there is full )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 409.06 Tm (compliance with all requirements. This relates particularly improvements to the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 394.48 Tm (management of medication to maintain the health and well being of people living at the )Tj ET /F2 12 Tf BT 1 0 0 1 35.17 379.9 Tm (home.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 356.44 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 336.45 Tm (If you want to know what action the person responsible for this )Tj ET /F2 12 Tf BT 1 0 0 1 416.37 336.45 Tm (care home)Tj ET /F2 12 Tf BT 1 0 0 1 480.04 336.45 Tm ( is taking )Tj ET /F2 12 Tf BT 1 0 0 1 28.35 318.95 Tm (following this report, you can contact them using the details on page 4.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 298.96 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 28.35 278.96 Tm (The report of this inspection is available from our website )Tj ET /F2 12 Tf BT 1 0 0 1 380.85 278.96 Tm (www.cqc.org.uk.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 258.96 Tm (You can get printed copies from )Tj ET /F2 12 Tf BT 1 0 0 1 225.22 258.96 Tm (enquiries@cqc.org.uk or by telephoning our)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 238.97 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 (40)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 (40)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 124.35 w 34.6 378 m 562.54 378 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 101.85 w 33.47 366.75 m 563.66 366.75 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 32.35 313.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 419.88 m 564.79 313.62 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 31.27 314.7 m 565.87 314.7 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 (adequate)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 319.4 403.12 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 (There is published information about the home and the home has comprehensive )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 341.25 Tm (assessment tools. People wishing to live at the home can generally be assured their )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 323.76 Tm (needs can be met most of the time.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 299.01 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 206.8 w 34.6 185.43 m 562.54 185.43 l S 0.001 w 1 1 1 RG 22.5 w 32.35 279.83 m 564.79 279.83 l S 0.001 w 185.43 w 33.47 173.62 m 563.66 173.62 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 267.45 m 565.87 267.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 268.53 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 268.53 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 267.45 m 564.79 267.45 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 35.5 276.52 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 251.77 Tm (We looked at copy of the homes statement of purpose and service user guides, which )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 234.27 Tm (had been updated in August 2008. The documents contained comprehensive )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 216.78 Tm (information and each unit had an individual service user guide. We recommended that )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 199.28 Tm (the admission criteria for each unit should be included. This information was important )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 181.79 Tm (because each unit accommodated and cared for people with very different needs and )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 164.29 Tm (would give people comprehensive information about the service to help them make )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 146.79 Tm (decisions about the choice of home. We saw that that each person living at the home )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 129.3 Tm (had access to their own copies in the Welcome Pack in their bedroom. The )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 111.8 Tm (organisation included information about the range of fees in the service user guides.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 94.31 Tm ()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 (40)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 (We looked at the care records for people admitted to the home since the last key )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (inspection. The homes administrator provided us with evidence that the BUPA )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (contracts, terms and conditions had been issued to everyone admitted to the home )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (since November 2008 and there was a process to ensure that everyone living at the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (home would be given contracts with up-to-date terms and conditions and information )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (about their individual fees. The contracts did not include reimbursement for the free )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (nursing care element, Registered Nurses Care Contribution, \(RNCC\), as previously )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (recommended.)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 (There was evidence that everyone, except the people admitted to Bloomfield unit for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (palliative care, had a detailed assessment of their needs before they came to live at )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (the home. The records we looked at showed that whenever possible the person or )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (their representatives were involved in the assessment of needs, risks and planned )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (care. The QUEST, an assessment and care planning system, implemented by BUPA, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (encouraged staff and people receiving the service to take part in the assessment of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (their needs, and there was generally improved consistency with the information )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (recorded, which meant that people's needs were less likely to be misunderstood or left )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (unmet.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (There was evidence that the staff were using the BUPA QUEST documentation more )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (consistently completed. We also noted that generally as people's needs changed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (appropriate referrals were made to multi disciplinary professionals for reassessments, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (guidance and support to meet their needs.)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 saw evidence that the previous recommendation, to provide additional specialist )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (training for staff, had been actioned and the majority of staff on Palethorpe unit had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (received training in alcohol related dementia, mental health topics and learning )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (disabilities. When we spoke to staff on this unit we noted that they were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (knowledgeable and confident in recognising and understanding the needs of people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (living in Palethorpe.)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 (There were improved mechanisms and evidence to show that staffing levels were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (generally monitored and revised proactively in accordance with occupancy and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (dependency levels of people living on each unit. For example we noted that there was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (an extra care assistant on duty for the early shift at Bloomfield and staff told us this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (had made a considerable difference to the way they were able to respond to people's )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (needs. However this was not the case on all units and our observations at Haines and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (Manby showed that the allocation and management of staff were disorganised. This )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (meant that in some instances increasing needs and dependency levels resulted in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (people not receiving the care they needed. We received comments from discussions )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 (40)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 56.36 w 34.6 783.22 m 562.54 783.22 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 34.99 w 33.47 771.41 m 563.66 771.41 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 32.35 751.71 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 751.71 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 31.27 752.79 m 565.87 752.79 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 (with people living at the home, relatives, and staff that at times the home was short )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (staffed and people did not always receive prompt attention.)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 (40)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 246.82 w 34.6 350.76 m 562.54 350.76 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 224.33 w 33.47 339.51 m 563.66 339.51 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 32.35 225.15 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 453.88 m 564.79 225.15 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 31.27 226.23 m 565.87 226.23 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 (There are care plans and risk assessments, which provide staff with guidance and are )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 375.25 Tm (generally adequate to met peoples needs. There are not always assurances that all )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 357.76 Tm (individual needs will be met for each person.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 340.26 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.62 322.77 Tm (The arrangements for administration of medication do not ensure that every person at )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 305.27 Tm (the home receives their medicines as prescribed by their doctor, which poses risks of )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 287.77 Tm (harm to their health and well being.)Tj ET /F2 12 Tf BT 1 0 0 1 36.62 270.28 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.62 252.78 Tm (People are generally treated with respect and courtesy, with rights to privacy and )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 235.29 Tm (dignity maintained.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 210.54 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 118.33 w 34.6 141.19 m 562.54 141.19 l S 0.001 w 1 1 1 RG 22.5 w 32.35 191.36 m 564.79 191.36 l S 0.001 w 96.96 w 33.47 129.38 m 563.66 129.38 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 178.98 m 565.87 178.98 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 180.06 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 180.06 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 178.98 m 564.79 178.98 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 35.5 188.04 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 163.3 Tm (We looked at of care records for a sample of people living in each of the five units. )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 145.8 Tm (There were considerable improvements, especially at three units, in the way the BUPA )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 128.31 Tm (QUEST documents had been used to assess and plan to meet each persons needs. The )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 110.81 Tm (majority of care plans we saw were person centred and demonstrated people and / or )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 93.31 Tm (their representatives had been involved in developing the plans for their care and )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 (40)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 (support. There were less variances in how well the healthcare screening tools, risk )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (assessments and care planning were implemented, monitored and maintained. This )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (meant that generally persons living at the home could feel assured that all their care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (needs were known about, understood and would be met.)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 (All units had a number of people with complex needs. Haines, Manby, Palethorpe and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (Bloomfield had a number of people needing to be nursed entirely in bed, and some of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (these people required end of life care. It was positive to note that the organisation had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (responded to the requirement made at the last key inspection in November 2008 and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (had provided 18 new nursing profile beds. This meant that people were being cared )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (for in beds, which minimised some of their discomfort, especially when needing a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (change of position. The managers present at this inspection told us that additional )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (nursing profile beds were on order.)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 were worried that not all units had made the same positive progress. Notably the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (care provided and care records on Haines unit were disorganised. For example, in one )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (person's care file though we eventually found that all the information needed, it was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (difficult to follow and actions had clearly been overlooked, which resulted in her needs )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (not being met. We noted that this person's condition had deteriorated in a short space )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (of time, and this person had lost weight and had developed numerous pressure ulcers, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (despite pressure relieving equipment and involvement of the GP and tissue viability )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (nurse specialist. Whilst it was positive that there was a revised plan "nursed in bed," )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (the lifestyle profile, was out of date and inaccurate, stating "gets up at 10:30 a.m., )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (breakfast in room, reads daily paper, watches TV, lunch in bedroom, goes to bed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (around 1700 hrs." We also noted in the records that on 11/5/09 the GP had requested )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (\(Methicillin Resistant Staphylococcus Aureus\)MRSA screening, however there was no )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (indication that this has been done or any evidence of the result in the records. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (quality manager gave us information later in the first inspection day that the screening )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (had been done and a bacterial infection had been identified. She assured us that the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (GP had been requested to visit and the appropriate antibiotic would be prescribed. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (made it clear that it was not satisfactory that no action was taken until prompted by )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (inspectors, this was acknowledged by managers from the organisation.)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 (Furthermore, this person had a recorded weight loss of 5.5 kg since May 2009, she )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (still remained on nursing care plan 'A' for eating and drinking, which did not prompt )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (further intervention. We were told that there were records of change of position, but )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (there were no food or fluid charts in place. We observed this person in their bedroom )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (and noted a bowl of cornflakes congealed and not eaten on the over-bed table out of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (reach, with a beaker of cold tea, recorded as offered but nothing recorded as taken. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (The person with a very dry mouth, unable to reach the drink or breakfast was )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 (40)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 (observed crying in pain but could not say where. The medication records showed that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (this person had not received any pain relieving medication for at least four days, since )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (the new \(Medication Administration Record\) MAR chart started. The quality manager )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (told us later in the day that food or fluid charts had been put in place and the GP had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (prescribed soluble pain relieving medication. We again stressed that it was not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (satisfactory, that staff took no action until prompted by us.)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 (On the same unit we looked at the end of life care being given to someone being )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (nursed in bed. We observed that the person looked very frail, with dry, flaky skin and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (we noted that there was a beaker of cold tea on the over-bed table. There were fluid )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (balance records in place in the bedroom, with fluid intake and output from catheter )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (recorded. However though the total fluid intake looked adequate there was only one )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (entry for urinary output and no total or variance recorded for the 24 hour periods. This )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (meant the monitoring of this person's condition was not effective and their needs were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (not being met. The accuracy of the records could not be relied on and other )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (complications could have been missed. We discussed the implications with the quality )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (manager and the acting manager who acknowledged that the incomplete information )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (would result in the person's condition not being monitored or managed for their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (comfort.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (The care records and delivery of care on Bloomfield unit, which provided palliative care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (and care for frail older people were generally excellent. On the sample of care records )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (we saw that the end of life care plan considered psychological, physical, spiritual )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (needs. There was documented involvement of family with no restrictions, and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (arrangements for overnight stays as needed. There were also anticipatory )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (prescriptions in place for symptom control and the advanced care plan documentation )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (was in place for when 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 looked at one person's daily records, which were generally well completed, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (however only 4 feeds, instead of the presribed 5 feeds, had been administered on )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (27/5/09 and there were three days where it was not recorded that the enteral feeding )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (tube had been rotated 360 degrees. We discussed these omissions with the unit )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (manager, who acknowledged the deficits in the records and gave us assurances that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (these omissions would be investigated and dealt with.)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 (We talked to a small number of people staying on Bloomfield unit for respite care, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (they told us that they were impressed with their accommodation, that they liked the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (food and that they found the staff "wonderful, friendly and helpful.")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 care records and delivery of care to people living on Palethorpe unit, for younger )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 (40)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 (adults with chronic illnesses, were also very person centred and well organised. There )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (were a small number of improvements we recommended. An example was actions in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (one person's review notes "going to reorganise Caribbean get together like in the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (past" and "ask X to teach sign language". There was no written evidence these actions )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (had been followed up. We discussed this with the unit manager who told us that the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (speech and language therapist had stated that it was not possible for this person to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (use sign language. We recommended that discussions and decisions should be fully )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (recorded in the persons care notes. This person with no verbal communication had a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (very detailed communication care plan but we asked the unit manager whether a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm ('picture board' or electronic device had been considered. She told us that they had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (pictures of food to assist making choices. We saw that it was recorded this person had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (refused to have blood tests. We discussed this person's refusal with the unit manager. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (As the person had been assessed as not having capacity under the Mental Capacity )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (Act 2005, we strongly recommended that a review be held with the person's )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (Independent Advocate, GP and Social Worker for decisions to be agreed in the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (person's 'best interests'. We also recommended that more specific information relating )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (to diabetic checks would enhance the care plans for this condition.)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 (Another person's care records indicated a referral had been made to a continence )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (advisor but additional information should be recorded about what to do if the catheter )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (comes out or needs replacing. This person also had a care plan in place for restless )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (sleep, but the reviews of the care plan show that the person was sleeping well, staff )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (also confirmed this. The home should feel confident to discontinue care plans if )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (problems are no longer relevant.)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 (We looked at the care of a person on Heronville who was assessed as needing )Tj ET /F2 12 Tf BT 1 0 0 1 511.39 341.7 Tm (one-to-)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (one)Tj ET /F2 12 Tf BT 1 0 0 1 56.35 324.2 Tm ( care. When we spoke to staff on this unit none of them knew what this meant. It )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (was not indicated on the staff rota that there were extra staff in place. However there )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (was funding from the placing authority for the one-to-one placement and we could see )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (from the rota that an extra staff member was available. We stressed the importance )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (of clear communication and guidance for staff so that they could provide the required )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (care and monitoring for this person. It was positive that the unacceptable behaviour of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (this person had been reported to the CQC and Local Authority and we were told that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (since the extra funding had been agreed there had not been further incidents.)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 (We saw generally good evidence overall of referrals to GP's and other healthcare )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (professions, such as the Speech and language therapists, dieticians, dentists, optician )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (and chiropodists, though this varied from unit to unit.)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 sample of plans we looked at on other units, for the people with complex needs or )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 (40)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 (towards the end of their lives, generally did not consider all areas of the persons life )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (including health, specialist treatments, personal and social care needs.)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 looked at the care of a people with diabetes, which was again variable across the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (units, with some generally well managed, with information relating to diet, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (medication, and heath care monitoring. On units such as Haines the diabetic care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (plans were not sufficient and did not give staff guidance to manage the condition to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (maintain or promote health and well being. We again highlighted the services offered )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (by the diabetic nurse specialist service in Sandwell and recommended that contact be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (made with the diabetic nurse specialist team to provide additional support, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (information, and appropriate specialist diabetic training for the trained nurses and care )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (staff.)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 (The pharmacist inspector visited the home on 28th May 2009 to check the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (management and control of medicines within the service. The pharmacist inspector )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (visited three out of the five units. We found that there had been an overall )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (improvement in the management of medication in two of the units, however it was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (disappointing that one of the units was found to be poor and was placing the health )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (and wellbeing of the people who use the service at risk.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (Staff had undergone a Medication Administration Assessment. We were shown )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (documentation to confirm this. Quality managers did the assessments in March and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (April 2009. We were informed that if there were any issues identified such as a gap in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (knowledge then the member of staff was re-tested. Further training was also done in a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (medication management workshop. This means that staff who administer medication )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (have been assessed as competent to do so and ensure the safety of the people who )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (use the service.)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 (The room temperature of the three medication storage rooms was below 25 degrees )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (centigrade, which is the correct storage temperature for medication. The refrigerators )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (in each unit were also within the correct temperature range of 2 to 8 degrees )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (centigrade. We saw daily records for the room and refrigerator temperatures, which )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (showed that medication was being stored at safe temperatures.)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 (We were concerned that the time period between the morning and lunchtime )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (medication rounds had not been addressed since the previous inspection. For )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (example, in Manby House we saw that the morning medication administration began )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (at 9am but did not finish until 11.30am.We were informed that the lunchtime )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (medication administration began at 2pm, which did not ensure that there was an )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (adequate gap between doses to ensure the safety of people living at the home.)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 (40)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 ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (Medication records were seen and it was acknowledged that overall there was an )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (improvement in two of the units with regard to recording the receipt, administration )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (and disposal of medication. It was therefore disappointing that this was not seen in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (one unit. It was concerning that we saw that three people had not received their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (medication as prescribed. Two people's medication had been out of stock for eight and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (five days respectively before a new supply was obtained. We spoke to the nurse in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (charge who could not give an explanation for this. A third person had not received )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (medication on two evenings due to an error that was not clearly documented. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (nurse in charge informed us that she believed it was an agency nurse. There was no )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (record to show if a Doctor had been informed about any of these incidents. This )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (increases the risk of harm to the health and wellbeing of the residents.)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 (The record of receipt of medication was not always documented. For example, we saw )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (a new supply of tablets in a cupboard, which had not been recorded as received onto )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (the resident's medication chart. This means that the total quantity available in the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (home was not accurately documented and therefore increases the risk of incorrect )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (medication supply.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (Medication was not always handled with care or safely and this increased the risk of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (harm to the people who live in the service. For example, we saw a medicine tot )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (containing two white tablets placed in the door of a medicine trolley. We identified the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (medication and asked the nurse in charge why it had not been administered or )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (destroyed. She could not offer an explanation. On further checking we found a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (medication chart with the two identified tablets. On 27th May 2009 the nurse in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (charge had documented the chart as RD, which was a code for refused and destroyed. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (We checked with the nurse in charge who agreed that the medication had been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (refused but it had not been destroyed in error. This was undertaken immediately. This )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (poor management of medication increases the risk of a medication error.)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 (Medication was not always checked to ensure the person took it safely before the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (medicine chart was documented. For example, a care assistant found a tablet on the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (nightdress of a person nursed in bed. We checked the medication administration chart )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (and saw that all of the morning medicines had been signed as administered by an )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (agency nurse, however one of the tablets had not been taken. This means that people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (who live in the service are at risk of not receiving their medication as prescribed and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (this increases the risk of harm to their health and wellbeing.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (Information relating to medication was not always available. For example, one person )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (was prescribed a painkiller to be given four times a day when required. We saw no )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 (40)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 371.29 w 34.6 625.76 m 562.54 625.76 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 349.92 w 33.47 613.95 m 563.66 613.95 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 32.35 436.79 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 436.79 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 31.27 437.86 m 565.87 437.86 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 (written information to inform staff under what circumstances the painkiller should be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (given. This was of concern because we witnessed the resident crying with pain and the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (records seen showed that no painkiller had been given since the start of the new )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (medication chart. We saw no written review of the pain relief and no reason was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (documented to explain why the painkiller was not being administered. We discussed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (our concern with the quality manager and a doctor was contacted and a dispersible )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (painkiller was prescribed. It was of concern that this healthcare need had not been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (undertaken by staff and therefore increased the risk of harm to the health and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (wellbeing of people living in the service.)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 spoke to some relatives, who were generally satisfied with the care provided. One )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (relative was not satisfied and we were made aware of a complaint, which the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (organisation was trying to resolve.)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 heard from some staff who told us that there are sometimes staff shortages but )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (they try their best to meet each persons needs. We saw that staff treated people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (living at the home with respect and courtesy, maintaining their privacy and dignity. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (People living at the home looked well presented and were appropriately dressed for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (the time of year. During discussions staff demonstrated a good understanding of how )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (to people wished to have their care provided.)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 (40)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 176.84 w 34.6 419.75 m 562.54 419.75 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 154.34 w 33.47 408.51 m 563.66 408.51 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 32.35 329.13 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 487.88 m 564.79 329.13 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 31.27 330.21 m 565.87 330.21 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 (There are generally more opportunities for activities and social stimulation for people )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 409.25 Tm (living at the home. People are encouraged and supported to maintain important )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 391.76 Tm (relationships and friendships. There are choices of generally nutritious meals )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 374.26 Tm (throughout the day and night. Some people at the home may not consistently receive )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 356.77 Tm (appropriate levels of support to maintain good levels of nutrition and hydration, which )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 339.27 Tm (may pose risks to their health and well being.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 314.52 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 222.31 w 34.6 193.18 m 562.54 193.18 l S 0.001 w 1 1 1 RG 22.5 w 32.35 295.34 m 564.79 295.34 l S 0.001 w 200.94 w 33.47 181.37 m 563.66 181.37 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 282.97 m 565.87 282.97 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 284.04 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 284.04 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 282.97 m 564.79 282.97 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 35.5 292.03 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 267.28 Tm (We saw there were improved records of each person's preferred daily routine recorded )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 249.79 Tm (in the sample of care plans examined, which provided staff with information to follow. )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 232.29 Tm (There were improvements to the flexibility of routines on some units but the morning )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 214.79 Tm (routines on Haines and Manby units were still disorganised. We saw evidence that not )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 197.3 Tm (all personal preferences had been updated, as highlighted at the previous section of )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 179.8 Tm (this report, and though staff were working hard, people were waiting unacceptable )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 162.31 Tm (lengths of time for their personal care, breakfasts and medication on these units. We )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 144.81 Tm (saw an example of a care assistant requesting the bank nurse to administer )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 127.31 Tm (someone's insulin at 11:20am so that this person could have their breakfast. Another )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 109.82 Tm (person still lying in bed at 10:15am told us that they often had to wait for attention )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 92.32 Tm (and though they did not mind waiting until about 10am, they disliked having to wait )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 (40)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 (longer.)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 (It was positive that when people had received assistance with their personal care they )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (generally look well groomed, with appropriate clothing for the time of year, and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (attention to detail, such as wearing jewellery of their choice.)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 (Each unit had activities co-ordinators, who worked from 10:00am to 4:00pm, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (Mondays to Fridays. We talked to the activities co-ordinators on three of the units, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (who told us of increased opportunities to met with each other and develop activities.)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 (Each unit had activities notice board displayed in the reception area. A sample of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (activities advertised were, hairdressing, reminiscence, board games, quizzes, singing, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (Holy Communion Service, and one-to-one sessions for people in bed or in their )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (bedrooms.)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 (There were designated activities rooms on some units, where we were told people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (could make cards, crafts, play skittles or have hand massages. The activities room on )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (Bloomfield unit also had a supply of radios and CD players for people who were too ill )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (to watch TV.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (We were told that there were entertainments such as singers and services at the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (home on various units and people who were able, were invited to attend from other )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (units. We were told that Palethorpe unit had outings last year to the safari park and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (Blackpool and were planning for a trip Southport this year with about 18 or 19 )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (residents plus staff and relatives in a 54 seater hire coach. The activities co-ordinator )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (told us people are registered with Ring and Ride and there have also visited Sandwell )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (Valley Park. There were plans to take residents buy bedding plants, and then help to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (plant them. We noted one person living at Palethorpe unit also attended the Beacon )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (Centre for the blind. We were told this person loves to water the plants, and the unit )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (bought an extended hose so that he did not water his slippers.)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 activity records were variable throughout the five units and some demonstrated )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (people were offered more social stimulation appropriate to their individual needs, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (especially for people with dementia or sensory impairments. We noted that there were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (considerable improvements to the environments on Manby and Heronville to provide )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (sensory stimulation for people with dementia.)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 (Whilst we were visiting Heronville unit the same piece of music was played )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (continuously and we counted 15 repeats of the 'White cliffs of Dover'. We pointed this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (out to the person in charge, it may have been that staff were so busy they did not )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 (40)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 (notice this but for people living in the home this could begin to be very annoying and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (cause agitation and distress. Once pointed out to staff, they changed the music.)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 (Staff spoken to said 'we do our very best, we can see that there are improvements )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (being made and this makes us want to do our best'. The environment on Heronville )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (was much improved since our last visit. Small lounges have been sectioned off offering )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (more choice quieter areas for people to sit.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (We saw a number of visitors during the two day inspection, though the majority of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (people told us that they felt generally felt welcomed, there were a variety of views. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (One relative told us she felt some staff worked very hard and were attentive to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (individual needs, but others did not. We discussed this person's concerns with the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (managers, who agreed to meet and discuss a way forward.)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 (The mealtimes observed on Haines and Manby units were protracted, and we were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (told significant numbers of people needing individual support to be fed, or assistance, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (support or encouragement to eat.)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 (Breakfast on Manby unit was observed. We saw there was a choice of hot breakfast, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (bacon sausage and eggs. We tasted the scrambled egg, which was unpleasant. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (requested that the staff also taste the egg and they agreed it was unpalatable. On the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (second day of the inspection we noted that the poached eggs offered for breakfast )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (were much better.)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 (During the two day visit we noted that the liquidised meals were thick and sticky and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (we saw staff adding water to loosen up the consistency. We were told that pureed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (meals were generally tasteless, which was confirmed when we tasted a small sample. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (We discussed our findings with the management of the organisation and with the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (recently appointed head chef. We were given assurances improvements would be )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (introduced and monitored.)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 (Whilst on Manby unit we observed carers supporting people at meal times and saw )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (staff offer people choices of drinks, such as tea, coffee or juice, which was positive. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (However one carer demonstrated this good practice, whilst wearing disposable blue )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (plastic gloves and plastic apron. She stood at the side of one person, and although she )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (spoke to them whilst feeding them she did not sit down, take her gloves off or give )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (the person any eye contact during this time. This detracted from the positive aspects )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (of the offers of choice. We noted that there was also music playing but it was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (competing with two televisions in the same area, demonstrating a lack of attention to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (peoples comfort and pleasure when eating.)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 (40)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 633.73 w 34.6 494.54 m 562.54 494.54 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 612.36 w 33.47 482.73 m 563.66 482.73 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 32.35 174.35 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 174.35 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 31.27 175.42 m 565.87 175.42 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 ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (In contrast the breakfast time observed on Bloomfield was a leisurely, relaxed social )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (occasion, with people who were able to sit at tables, enjoying conversation. The )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (people we spoke to on this unit were complimentary about the food in general and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (enjoyed their breakfast of a choice of cereals, toast and conserves, poached eggs on )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (toast or bacon sandwiches, with fruit juice and plentiful hot drinks.)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 (It was positive that in the units dining tables were attractively laid with table clothes, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (placemats, condiments and attractive table decorations and efforts had been made for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (social interaction and for mealtimes to made 'special'.)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 noted whilst on Heronville, the housekeeper had cleared the hot breakfast away at )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (10.50 am, then at 11.10 am carers bought one person into the dining area for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (breakfast, he was only offered toast because there was nothing left for him to eat. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (observed lunch on this unit and noted that the same person was still sitting at the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (table at 12:30pm and was not eating his meal. We saw, as at the previous inspection )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (in November 2008, that there were a lot of people who needed assistance with eating )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (and drinking on Heronville, We spoke to staff about this they said, we manage but it is )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (very hectic at times. One person served meals and checked that people were given )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (what they had chosen.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (We observed the lunch served on Palethorpe unit observed lunch on the second day of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (the inspection and tasted the food because staff had said that it was boring and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (always the same for those people who needed soft diets. The mashed potato and peas )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (were salty, and the liquidised food was abysmal, watery and lumpy at the same time. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (Some of the people on the unit said, 'the food is very nice', one person used to be a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (chef and said that the food 'is generally very good, and especially liked the coffee )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (mousse on offer this day'.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (We discussed the issue of food and the reduced quality of it for some people. We were )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (told that the home had already consulted with residents about this, and had received )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (their comments. A new chef had been appointed and during discussion he told us he )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (was well aware of the concerns that people had about the food and was planning a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (meeting with residents and relatives to address these concerns and put a menu in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (place that meets all people's choices.)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 (40)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 124.35 w 34.6 497 m 562.54 497 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 101.85 w 33.47 485.75 m 563.66 485.75 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 32.35 432.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 538.88 m 564.79 432.62 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 31.27 433.7 m 565.87 433.7 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 (adequate)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 319.4 522.12 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 (People can generally have confidence their concerns or complaints will be listened to )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 460.25 Tm (and investigated and the management practices generally protect people from harm )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 442.76 Tm (or abuse.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 418.01 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 325.8 w 34.6 244.93 m 562.54 244.93 l S 0.001 w 1 1 1 RG 22.5 w 32.35 398.83 m 564.79 398.83 l S 0.001 w 304.43 w 33.47 233.12 m 563.66 233.12 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 386.45 m 565.87 386.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 387.53 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 387.53 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 386.45 m 564.79 386.45 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 35.5 395.52 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 370.77 Tm (The complaints procedure was displayed on the main notice boards in the reception )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 353.27 Tm (areas of the home and was also included within the Welcome Pack and within the )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 335.78 Tm (service user guide. This helped people to understand who to approach if they are )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 318.28 Tm (unhappy or wish to express concerns.)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 (There had been no change to the organisations complaints policy since the last )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 265.79 Tm (inspection in November 2008. There have been eight complaints since January 2009, )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 248.3 Tm (and there were recorded investigations and responses. We noted that in January 2009 )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 230.8 Tm (there was one complaint about the nurse call system not working, this had been )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 213.31 Tm (addressed by the handyman and the bleep system was sent away for repair. We )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 195.81 Tm (checked the handyman's audit of the home and he had written 'nurse call system is in )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 178.31 Tm (urgent need of upgrade' this has yet to be done by the home.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 160.82 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 143.32 Tm (On a positive note we saw many cards of thanks and compliments from relatives, )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 125.83 Tm (displayed on the notice boards in the reception areas of each unit, complimenting the )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 108.33 Tm (staff and care at the home. We noted that the home had received 38 compliments for )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 90.83 Tm (the service it has provided since the beginning of the year.)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 (40)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 336.3 w 34.6 643.26 m 562.54 643.26 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 314.93 w 33.47 631.44 m 563.66 631.44 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 32.35 471.78 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 471.78 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 31.27 472.86 m 565.87 472.86 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 ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (There are better systems in place for the protection of vulnerable people. We have )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (seen the home was reporting issues to safeguarding team as they should. We followed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (up a Regulation 37 notification in relation to a male living at the home inappropriately )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (touching a female living on the same unit. We referred to this issue in the personal )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (and health care section of this report. The management of the home had worked with )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (the Local Authority and health professionals and had secured one-to-one funding for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (the person. We noted the involvement of the community mental health team and that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (they were looking for another more appropriate placement for this person. The other )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (person involved in the incident did not appear to have been upset.)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 spoke to a number of staff and they were all aware of who to report concerns to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (and when they should do this. We were given confirmation that staff had been given )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (training in relation to safeguarding vulnerable people.)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 (The organisation needed to put in place more robust measures when recruiting new )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (staff and using agency workers to improve safeguards for people living at the home. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (This is detailed at the staffing section of this report.)Tj ET endstream endobj 68 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 69 0 obj <>stream 0 J 0.75294 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 (40)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 124.35 w 34.6 480 m 562.54 480 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 101.85 w 33.47 468.75 m 563.66 468.75 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 32.35 415.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 521.88 m 564.79 415.62 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 31.27 416.7 m 565.87 416.7 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 incremental changes to the decor and furnishings contribute to creating a pleasant )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 443.25 Tm (environment for people to live in. The grounds are generally maintained to provide a )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 425.76 Tm (safe and interesting outdoor environment for people at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 401.01 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 308.8 w 34.6 236.43 m 562.54 236.43 l S 0.001 w 1 1 1 RG 22.5 w 32.35 381.83 m 564.79 381.83 l S 0.001 w 287.43 w 33.47 224.62 m 563.66 224.62 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 369.45 m 565.87 369.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 370.53 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 370.53 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 369.45 m 564.79 369.45 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 35.5 378.52 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 353.77 Tm (We looked at each of the five units, which accommodated the people living at the )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 336.27 Tm (home. We looked for evidence that improvements, which were needed at the last )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 318.78 Tm (inspection, to see if they had been actioned. We saw some evidence that the home )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 301.28 Tm (was now being proactively maintained to more acceptable standards with an ongoing )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 283.79 Tm (repairs, maintenance and renewal programme.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 266.29 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 248.79 Tm (The units had been redecorated to offer more stimulation for people on Manby and )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 231.3 Tm (Heronville. We saw reminiscence pictures in the corridors, musical instruments, and )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 213.8 Tm (grab rails had been painted red to aid recognition for people and provide guidance. )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 196.31 Tm (The courtyard garden on Heronville was very inviting and gave people somewhere )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 178.81 Tm (pleasant to visit. Seating, scented plants and ornaments made it a pleasing place to )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 161.31 Tm (be. During the tour of Bloomfield unit we spoke to people staying for respite care who )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 143.82 Tm (were all very complimentary about their environment and the garden area, called 'the )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 126.32 Tm (garden of joy' was particularly attractive and relaxing.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 108.83 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 91.33 Tm (We saw that the garden area on Palethorpe unit was in use during the inspection, )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 (40)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 (people on this unit had taken time to plant and take care of the garden themselves. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (There was a lovely patio area for people to enjoy and raised beds for those people )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (who were unable to manage gardening any other way. However we noticed that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (people on Palethorpe who needed to use wheelchairs were not able to get into the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (building unaided because of a raised step on the patio door. This was bought to the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (attention of the person in charge and they immediately agreed to take action to create )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (better access.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (On another unit, where we identified areas, which needed improvements at this visit, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (the management of the organisation were swift to act. An example was on Haines unit )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (in bedroom 28, where there was someone, who was very small and frail and had )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (bedrails with bedrail bumpers in place, but we noted a gap at the top of the bed )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (between bedrails and headboard. When the gap was measured it was within permitted )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (dimensions but the quality manager and acting manager acknowledged that this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (needed to be managed with more safety. We were told by the quality manager during )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (the first morning of this visit that a nursing profile that had been ordered and would )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (be delivered as soon as possible. This demonstrated very proactive and positive )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (practice.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (We were shown some of the eighteen new nursing profile beds provided since the last )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (inspection and we were told there were more on order. We saw that there were new )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (comfortable chairs, dining tables and chairs on Heronville.)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 (During our tour we noted that bathrooms throughout the site were generally clean, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (though some were very clinical and on Manby, Heronville and Palethorpe, storage was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (still a problem.)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 (Some people had been able to individualise their bedrooms with personal possessions. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (However on units such as Manby, Haines and Palethorpe the majority of bedrooms )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (needed to be redecorated and refurbished.)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 noted that all of the people whose care we looked at closely had the equipment in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (place that they needed such as pressure mattresses and cushions.)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 (We found throughout the home that there was generally a satisfactory supply of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (gloves and aprons and liquid soap. These items were available to help to reduce the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (risk of cross infection to people living at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (We identified some additional areas, which needed to be improved at this visit, such )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (as:)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 (40)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 ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (Bloomfield, room 37, shower room, we noted that the base of the assisted bath was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (very worn and in need of renovation, to maintain good infection control measures.)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 (Bloomfield, bathroom 16. We noted a new bath panel was required, the existing panel )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (was cracked and ill fitting.)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 (Palethorpe, WC room 23 the door would not close into the rebate. WC room 24 door )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (not closing at all and plinth with WC was not able to be cleaned effectively and was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (causing a malodour. Bathroom 31 there were similar problems with plinth and flooring )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (causing a malodour. The Arjio bath not working, awaiting parts. Radiators and pipe )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (work were not guarded, these must be risk assessed and guarded to avoid risks of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (harm to people using this facility. These issues pose risks to people's safety and did )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (not demonstrate their privacy and dignity was being maintained.)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 (Palethorpe, some of the furniture needed replacing, there were at least six chairs that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (were ripped, with exposed foam and in need of replacement. The unit manager told us )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm (that they were on order.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (The whole environment on Palethorpe needed upgrading, walls were battered from )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (wheelchair use, wallpaper ripped in places.)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 (Manby the garden was overgrown, with grass and plants approximately 12 inches high )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (making access impossible for people living at the home.)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 (Heronville, staff were completing an audit of all the beds and bed rails that need )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (replacing, we noticed that pillows needed replacing and duvets were thinning. Towels )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (were also frayed.)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 (40)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 124.35 w 34.6 480 m 562.54 480 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 101.85 w 33.47 468.75 m 563.66 468.75 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 32.35 415.62 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 521.88 m 564.79 415.62 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 31.27 416.7 m 565.87 416.7 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 numbers and skill mix of staff generally meet the needs of people living at the )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 443.25 Tm (home. Recruitment and selection procedures are not sufficiently robust to safeguard )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 425.76 Tm (vulnerable people.)Tj ET /F2 12 Tf BT 1 0 0 1 28.35 401.01 Tm ()Tj ET 0.99608 0.9451 0.76078 RG 308.8 w 34.6 236.43 m 562.54 236.43 l S 0.001 w 1 1 1 RG 22.5 w 32.35 381.83 m 564.79 381.83 l S 0.001 w 287.43 w 33.47 224.62 m 563.66 224.62 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 31.27 369.45 m 565.87 369.45 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 370.53 m 32.35 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 370.53 m 564.79 78.7 l S 0.001 w [] 0 d [] 0 d 2.25 w 32.35 369.45 m 564.79 369.45 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 35.5 378.52 Tm (Evidence:)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 353.77 Tm (The staffing rotas demonstrated there were usually sufficient numbers of nurses, )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 336.27 Tm (carers and ancillary staff and we were told that managers now regularly monitored )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 318.78 Tm (residents' dependencies and occupancy levels and reviewed and revised staffing )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 301.28 Tm (levels, and made adjustments accordingly. We noted that additional care staff had )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 283.79 Tm (been allocated to the early shifts on Bloomfield unit and staff told us that it had made )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 266.29 Tm (a considerable difference. However we saw and heard about people waiting for )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 248.79 Tm (attention, especially medication, assistance with feeding and to be taken to the toilet. )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 231.3 Tm (We discussed our observations with the BUPA management, present at this inspection )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 213.8 Tm (and we received assurances that they would be evaluating the deployment and )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 196.31 Tm (effectiveness of staff to make sure that people were not put at risk with inappropriate )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 178.81 Tm (timings of medication administration or unacceptable waiting times for attention.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 161.31 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 36.57 143.82 Tm (There is a recruitment and selection procedure in place. We spoke to one staff )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 126.32 Tm (member who felt that their recruitment had been done fairly. We looked at the files for )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 108.83 Tm (six members of staff. We did this to check the recruitment practices. Generally files )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 91.33 Tm (were well ordered and sub-divided. This made it easier to look through the files. We )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 (40)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 686.22 w 34.6 468.3 m 562.54 468.3 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 664.85 w 33.47 456.48 m 563.66 456.48 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 32.35 121.86 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 121.86 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 31.27 122.93 m 565.87 122.93 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 (found evidence of application forms, references, proof of identity and criminal record )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (checks. Staff were occasionally started on a \(Protection of Vulnerable Adults\) POVA )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (First basis whilst waiting for their full check to come back. Where this is the case, we )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (saw evidence of an existing member of staff to be "buddied" with that person for each )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (shift. We found interview records for care assistants and panel interview records for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 691.62 Tm (nurses. Good practice would indicate a panel interview for all potential candidates to )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (show fairness and equity. On three files we saw references, which either gave us )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (cause for concern or said that the referee would not re-employ the person. We found )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (gaps in employment histories on the application forms for two people. We could not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (find any evidence of how these issues had been explored. The agency employs staff )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (who required work permits. We saw evidence that two work permits had expired but )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (the registered persons were continuing to allow the staff to work. Additionally we )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (found that the home uses agency staff from an external organisation. Although the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (organisation has an agreement to use this provider, we could not see how the home )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (has checked the individual information for each agency member of staff they use. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (These systems need to be improved to show how the service is fully safeguarding )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (people through its recruitment practices.)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 (There are two separate inductions, one for nursing staff and one for care assistants. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (Both have booklets, which they can work through. The care assistants receive a )Tj ET /F2 12 Tf BT 1 0 0 1 522.45 446.67 Tm (two-)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (part)Tj ET /F2 12 Tf BT 1 0 0 1 58.86 429.18 Tm ( induction. The first part focuses on the home and key policies and procedures. We )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (saw evidence on all but one file of these being completed. The second part focuses on )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 394.19 Tm (the specification laid down by Skills for Care. Although given verbal assurances that )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 376.69 Tm (these had been completed, the home had no audit trail of this. This is because the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (staff can keep their workbooks and take them off site. There is an opportunity for each )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (standard to be signed off and we have asked the manager to look at how they can )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (show the work undertaken.)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 have been improvements in the level of training since our last inspection in )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (November 2008. There is a centralised training and development matrix. There was )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (evidence that staff were encouraged to undertake NVQ qualifications. Certificates and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (individual profiles are held on each file. Since then, there has been a home relief )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 219.23 Tm (manager working on a rolling programme of training. Staff had attended a range of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 201.73 Tm (training to include safeguarding, moving and handling, infection control and health )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (and safety. Additionally nursing staff are encouraged to attend training which they can )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (use as evidence of their learning for their nurse registration. Whilst we did see some )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (gaps, we are encouraged by the work undertaken to date and hope to see this )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm (continuing.)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 (40)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 (adequate)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 319.4 420.12 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 who live at the home cannot always be assured that the management )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 358.25 Tm (arrangements make sure that their health, well being and safety of will be )Tj ET /F2 12 Tf BT 1 0 0 1 36.62 340.76 Tm (safeguarded.)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 (This home had not had the stability of a consistent registered manager in post for )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 251.27 Tm (some time. The current registered manager, Ms Kalmit Jagpal had been in post since )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 233.78 Tm (September 2007. We were informed during the inspection visit that the current )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 216.28 Tm (registered manager had co-operated fully with the improvement plan for the home but )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 198.79 Tm (she would be moving to another home in the organisation in the near future. We were )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 181.29 Tm (introduced to the new acting manager, who took an active part in the inspection. She )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 163.79 Tm (told us that she had completed the BUPA corporate induction and was undertaking the )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 146.3 Tm ('on site' home induction. We had the opportunity to speak to the new acting manager )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 128.8 Tm (for the service. She has had some experience of managing large homes and is aware )Tj ET /F2 12 Tf BT 1 0 0 1 36.57 111.31 Tm (of the shortfalls in the service provision at Ryland View.)Tj ET /F2 12 Tf BT 1 0 0 1 36.57 93.81 Tm ()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 (40)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 (We were told that the home had a quality plan, which reviewed all areas of the home )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (at least annually. There were regular audits of the care plans and risk assessments. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (There were also medication audits, though these had not identified the failures )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (identified at this inspection. There were minutes to show that unit manager meetings )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 709.11 Tm (and staff meetings were held.)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 (We also saw reports of the Regulation 26 monitoring visits undertaken by the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (organisations representative. These were generally more robust, and though some )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 639.13 Tm (shortfalls had been identified at monitoring visits, these had not been rectified at the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 621.63 Tm (time of this inspection, such as the management, storage and administration of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (medication, as identified by the CQC Pharmacist.)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 results of the recent annual survey completed showed that there had been )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (deterioration in the satisfaction of the catering service, there was only a 61 per cent )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (satisfaction rate. The home had responded by surveying people again about the food )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 516.66 Tm (and catering service. The results were being collated and we spent time talking to the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 499.16 Tm (chef about the comments people had given to us about the food being 'vile' and )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 481.67 Tm ('tasteless' and our own findings confirmed these views. The chef was planning a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 464.17 Tm (meeting with families and people to discuss these issues and get to the bottom of the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 446.67 Tm (problem. Seventy five per cent of people surveyed said that they were happy with the )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 429.18 Tm (activity the home provides but more activity was needed. Relatives were also )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 411.68 Tm (surveyed with the same findings, the largest area of concern noted.)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 were told that managers on each of the units undertook staff supervision sessions. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 359.19 Tm (The registered manager in turn supervised them. The home told us that the level of )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 341.7 Tm (supervision has slipped on some of the units. We spoke to one member of staff who )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 324.2 Tm (had been employed for nearly 12 months. They told us they had not received a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 306.71 Tm (supervision session since they started employment. They said, "no supervision and I )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 289.21 Tm (think it is ridiculous" they continued, "they [supervisions] need to be done on a )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 271.71 Tm (regular basis". On a more positive note we spoke to some staff on Bloomfield unit who )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 254.22 Tm (told us they received regular supervisions sessions from the unit manager and found )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 236.72 Tm (this to be supportive and helpful.)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 (Maintenance records had been kept up to date. We checked hot water, air )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 184.23 Tm (conditioning, emergency lighting, and nurse call system. Health and safety training )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 166.74 Tm (was in place, and though there were gaps in the training matrix, remedial )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 149.24 Tm (arrangement had been made.)Tj ET /F2 12 Tf BT 1 0 0 1 34.32 131.75 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 34.32 114.25 Tm (We were told that the handyman carried out and recorded monthly bed rail checks, )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 96.75 Tm (and included measurement of gaps and permitted dimensions. The observations of )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 (40)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 283.81 w 34.6 669.5 m 562.54 669.5 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 262.44 w 33.47 657.69 m 563.66 657.69 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 32.35 524.27 l S 0.001 w [] 0 d [] 0 d 2.25 w 564.79 791.11 m 564.79 524.27 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 31.27 525.34 m 565.87 525.34 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 (bedrails during our tours of the premises showed that they were fitted and maintained )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 761.6 Tm (safely. However some areas of the home notably the bathing facilities were not )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 744.11 Tm (maintained to standards, which protected people at the home from risks of harm. )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 726.61 Tm (These areas were highlighted at the environment section of this report.)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 noted from our records and records held at the home that reporting Regulation 37 )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 674.12 Tm (notifications was much better, and generally incidents had been appropriately reported )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 656.63 Tm (to in accordance with safeguarding procedures.)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 looked at the accident records since the last inspection and noted that accident )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 604.14 Tm (reporting was better. We noted through case tracking that when people were having )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 586.64 Tm (falls and they had been reported appropriately. Reviews of falls risk assessments for )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 569.15 Tm (people included any falls that had occurred during the previous month and any action )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 551.65 Tm (the home had taken to address this. For example referrals to the rehabilitation team )Tj ET /F2 12 Tf BT 1 0 0 1 34.32 534.15 Tm (for falls prevention advice, and ordering low profiling beds and crash mats.)Tj ET endstream endobj 85 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 87 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 (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 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 (40)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 547.05 w 32.32 443.88 m 564.97 443.88 l S 0.001 w 1 1 1 RG 183.96 w 31.2 522.57 m 91.05 522.57 l S 0.001 w 183.96 w 93.3 522.57 m 197.4 522.57 l S 0.001 w 183.96 w 199.65 522.57 m 289.45 522.57 l S 0.001 w 183.96 w 291.7 522.57 m 473.8 522.57 l S 0.001 w 183.96 w 476.05 522.57 m 566.1 522.57 l S 0.001 w 256.86 w 31.2 299.91 m 91.05 299.91 l S 0.001 w 256.86 w 93.3 299.91 m 197.4 299.91 l S 0.001 w 256.86 w 199.65 299.91 m 289.45 299.91 l S 0.001 w 256.86 w 291.7 299.91 m 473.8 299.91 l S 0.001 w 256.86 w 476.05 299.91 m 566.1 299.91 l S 0.001 w [] 0 d 2.25 w 0.75294 0.75294 0.75294 RG 28.99 429.46 m 568.3 429.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 616.75 m 30.07 169.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.22 616.75 m 567.22 169.28 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 92.17 169.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 616.75 m 198.52 169.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.57 616.75 m 290.57 169.28 l S 0.001 w [] 0 d [] 0 d 2.25 w 474.92 616.75 m 474.92 169.28 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 28.99 429.46 m 568.3 429.46 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 170.35 m 568.3 170.35 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 (13)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 599.49 Tm (The records of the receipt, )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 584.91 Tm (administration and disposal )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 570.33 Tm (of medicines for the people )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 555.75 Tm (who use the service must be )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 541.17 Tm (robust and accurate to )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 526.59 Tm (demonstrate that all )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 512.01 Tm (medication is administered )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 497.43 Tm (as prescribed. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 479.85 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 465.27 Tm (This is to ensure residents )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 450.69 Tm (health and well being is )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 436.11 Tm (safeguarded. )Tj ET /F2 12 Tf BT 1 0 0 1 478.9 599.49 Tm (02/03/2009)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 416.28 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 413.28 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 413.28 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 294.55 413.28 Tm (Appropriate information )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 398.7 Tm (relating to medication must )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 384.12 Tm (be kept, for example, in risk )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 369.54 Tm (assessments and care plans )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 354.96 Tm (to ensure that staff know )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 340.38 Tm (how to use and monitor all )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 325.8 Tm (medication including, when )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 311.22 Tm (required medication, to )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 296.64 Tm (ensure that all medication is )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 282.06 Tm (administered safely, correctly )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 267.48 Tm (and as intended by the )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 252.9 Tm (prescriber to meet individual )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 238.32 Tm (health needs. )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 220.74 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 294.55 206.16 Tm (This is to ensure residents )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 191.58 Tm (health and well being is )Tj ET /F2 12 Tf BT 1 0 0 1 294.55 177 Tm (safeguarded. )Tj ET /F2 12 Tf BT 1 0 0 1 478.9 413.28 Tm (02/03/2009)Tj ET endstream endobj 88 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 89 0 obj <>stream 0 J 0.75294 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 (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 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 (40)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 16 Tf BT 0 0 0 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63.3 m 568.3 63.3 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 629.42 m 30.07 525.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.12 560.43 m 92.12 525.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.52 560.43 m 198.52 525.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 290.62 560.43 m 290.62 525.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 475.02 560.43 m 475.02 525.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 629.42 m 567.32 525.73 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 31.2 615.16 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 34.05 595.16 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 34.05 580.58 Tm (Standards Act 2000, Care Homes)Tj ET /F2 12 Tf BT 1 0 0 1 239.77 580.58 Tm (Regulations 2001 and the National Minimum )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 566 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 31.2 548.18 Tm (No.)Tj ET /F2 10 Tf BT 1 0 0 1 96.1 545.18 Tm (Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.5 545.18 Tm (Regulation)Tj ET /F2 10 Tf BT 1 0 0 1 294.6 545.18 Tm (Requirement)Tj ET /F2 10 Tf BT 1 0 0 1 479 545.18 Tm (Timescale for )Tj ET /F2 10 Tf BT 1 0 0 1 479 533.03 Tm (action)Tj ET /F2 12 Tf BT 1 0 0 1 35.5 513.62 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 513.62 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 513.62 Tm (11)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 513.62 Tm (The registered persons must )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 496.62 Tm (ensure that special care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 479.62 Tm (records such as food, fluid )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 462.62 Tm (balance charts and turn )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 445.62 Tm (charts are diligently )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 428.62 Tm (completed with care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 411.62 Tm (provided accurately )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 394.62 Tm (recorded and vigilantly )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 377.62 Tm (monitored, and with care )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 360.62 Tm (records updated as changes )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 343.62 Tm (occur.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 326.62 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 298.05 309.62 Tm (This is to ensure each )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 292.62 Tm (person's health and well )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 275.62 Tm (being is maintained.)Tj ET /F2 12 Tf BT 1 0 0 1 482.1 513.62 Tm (01/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 513.62 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 35.5 256.37 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 99.3 256.37 Tm (37)Tj ET /F2 12 Tf BT 1 0 0 1 201.55 256.37 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 256.37 Tm (The registered persons must )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 239.37 Tm (ensure any radiators and hot )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 222.37 Tm (water pipes, which are not )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 205.37 Tm (low surface temperature or )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 188.37 Tm (unguarded, are risk )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 171.37 Tm (assessed with remedial )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 154.37 Tm (measures implemented as a )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 137.37 Tm (priority.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 120.37 Tm (This is to safeguard people )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 103.37 Tm (living in the home from risks )Tj ET /F2 12 Tf BT 1 0 0 1 298.05 86.37 Tm (of harm.)Tj ET /F2 12 Tf BT 1 0 0 1 298.05 69.37 Tm ()Tj ET /F2 12 Tf BT 1 0 0 1 482.1 256.37 Tm (01/07/2009)Tj ET /F2 12 Tf BT 1 0 0 1 554.05 256.37 Tm ()Tj ET endstream endobj 90 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 91 0 obj <>stream 0 J 0.75294 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 (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 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 (40)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr 0.95294 0.95294 0.95294 RG 714.89 w 32.32 436.96 m 564.97 436.96 l S 0.001 w 1 1 1 RG 93.48 w 31.2 659.94 m 91.05 659.94 l S 0.001 w 93.48 w 93.3 659.94 m 197.4 659.94 l S 0.001 w 93.48 w 199.65 659.94 m 566.1 659.94 l S 0.001 w 93.48 w 31.2 564.21 m 91.05 564.21 l S 0.001 w 93.48 w 93.3 564.21 m 197.4 564.21 l S 0.001 w 93.48 w 199.65 564.21 m 566.1 564.21 l S 0.001 w 78.9 w 31.2 475.77 m 91.05 475.77 l S 0.001 w 78.9 w 93.3 475.77 m 197.4 475.77 l S 0.001 w 78.9 w 199.65 475.77 m 566.1 475.77 l S 0.001 w 49.74 w 31.2 409.2 m 91.05 409.2 l S 0.001 w 49.74 w 93.3 409.2 m 197.4 409.2 l S 0.001 w 49.74 w 199.65 409.2 m 566.1 409.2 l S 0.001 w 78.9 w 31.2 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[] 0 d 2.25 w 28.99 220.91 m 568.3 220.91 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 168.92 m 568.3 168.92 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 131.51 m 568.3 131.51 l S 0.001 w [] 0 d [] 0 d 2.25 w 28.99 79.52 m 568.3 79.52 l S 0.001 w [] 0 d [] 0 d 2.25 w 30.07 797.73 m 30.07 706.73 l S 0.001 w [] 0 d [] 0 d 2.25 w 92.17 728.16 m 92.17 707.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 198.47 728.16 m 198.47 707.81 l S 0.001 w [] 0 d [] 0 d 2.25 w 567.32 797.73 m 567.32 706.73 l S 0.001 w [] 0 d /F2 12 Tf BT 0 0 0 RG 0.5 w 2 Tr 1 0 0 1 34.05 780.47 Tm (Recommendations)Tj ET 0.75294 0.75294 0.75294 RG 0.001 w 0 Tr /F2 12 Tf BT 1 0 0 1 34.05 762.89 Tm (These recommendations are taken from the best practice described in the National )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 748.31 Tm (Minimum Standards and the registered person\(s\) should consider them as a way of )Tj ET /F2 12 Tf BT 1 0 0 1 34.05 733.73 Tm (improving their service.)Tj ET /F2 10 Tf BT 1 0 0 1 34.05 712.91 Tm (No)Tj ET /F2 10 Tf BT 1 0 0 1 96.15 712.91 Tm (Refer to Standard)Tj ET /F2 10 Tf BT 1 0 0 1 202.45 712.91 Tm (Good Practice Recommendations)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 691.62 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 691.62 Tm (1)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 691.62 Tm (It is recommended that the admission criteria for each unit )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 677.04 Tm (should be included. This information was important because )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 662.46 Tm (each unit accommodated and cared for people with very )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 647.88 Tm (different needs and would give people comprehensive )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 633.3 Tm (information about the service to help them make decisions )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 618.72 Tm (about the choice of home.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 595.89 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 595.89 Tm (2)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 595.89 Tm (Each person living at Ryland View should be given a )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 581.31 Tm (statement of terms and conditions detailing their fees, )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 566.73 Tm (including the free nursing care element, Registered Nurse )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 552.15 Tm (Care Contribution \(RNCC\) element, the provider )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 537.57 Tm (responsibilities and their rights and obligations whilst they )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 522.99 Tm (are resident at the home.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 500.16 Tm (3)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 500.16 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 500.16 Tm (That each person's last wishes in respect of death and )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 485.58 Tm (dying should be explored and be recorded within their end )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 471 Tm (of life care plan.)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 456.42 Tm (This is a previous good practice recommendation, which )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 441.84 Tm (was not met.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 419.01 Tm (4)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 419.01 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 419.01 Tm (It is recommended that more specific information relating )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 404.43 Tm (to specialist diabetic checks should be recorded in the care )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 389.85 Tm (plan for this condition.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 367.02 Tm (5)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 367.02 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 367.02 Tm (That manufacturers guidelines for use and maintenance of )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 352.44 Tm (pressure relieving mattresses should be available on each )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 337.86 Tm (persons risk assessment and care plan to ensure that they )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 323.28 Tm (are maintained that the correct pressure for the persons )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 308.7 Tm (individual care.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 285.87 Tm (6)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 285.87 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 285.87 Tm (It is strongly recommended that where people assessed as )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 271.29 Tm (lacking capacity refuse planned treatment or care, recorded )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 256.71 Tm (reviews should be held with the person's Independent )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 242.13 Tm (Advocate, GP, social worker and significant others for )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 227.55 Tm (decisions to be agreed in the person's 'best interests'.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 204.72 Tm (7)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 204.72 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 204.72 Tm (The garden area on Manby and Palethorpe should be made )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 190.14 Tm (accessible to ensure that all people living on these units are )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 175.56 Tm (able to have independent and safe access.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 152.73 Tm (8)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 152.73 Tm (15)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 152.73 Tm (The menus should be reviewed after consultation with )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 138.15 Tm (people using the service.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 115.32 Tm (9)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 115.32 Tm (21)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 115.32 Tm (That the action is taken to rectify defective bathing and )Tj ET /F2 12 Tf BT 1 0 0 1 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Tm (28)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 656.63 Tm (It is strongly recommended that more robust procedures )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 642.05 Tm (should be implemented for checking and validating people's )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 627.47 Tm (permits to work in the UK.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 604.64 Tm (12)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 604.64 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 604.64 Tm (It is strongly recommended that the organisation )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 590.06 Tm (implements processes to provide documentary evidence of )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 575.48 Tm (validation and induction for agency staff employed to work )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 560.9 Tm (at the home to safeguard the people living there.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 538.07 Tm (13)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 538.07 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 538.07 Tm (It is recommended that induction elements should be )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 523.49 Tm (signed off to provide an audit trail.)Tj ET /F2 12 Tf BT 1 0 0 1 34.05 500.66 Tm (14)Tj ET /F2 12 Tf BT 1 0 0 1 96.15 500.66 Tm (29)Tj ET /F2 12 Tf BT 1 0 0 1 202.5 500.66 Tm (It is strongly recommended that recruitment and selection )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 486.08 Tm (processes should be robust and procedures must be in )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 471.5 Tm (place to explore information provided by candidates, such )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 456.92 Tm (as documented investigations of any gaps in employment )Tj ET /F2 12 Tf BT 1 0 0 1 202.5 442.34 Tm (histories.)Tj ET endstream endobj 94 0 obj<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]>>/MediaBox[0 0 595 842]>> endobj 95 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 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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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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 <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 105 0 obj<> endobj 106 0 obj<>/Subtype/CIDFontType2/Type/Font/W [3[312]]/CIDToGIDMap/Identity/DW 1000>> endobj 107 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 108 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 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Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved %%CreationDate: Fri Oct 10 11:50:06 2008 % Converted from TrueType font 'SYMBOL.TTF' by ttf2pt1 program % %%EndComments 12 dict begin /FontInfo 9 dict dup begin /version (Version 1.60) readonly def /Notice (Typeface The Monotype Corporation plc. Data The Monotype Corporation plc/Type Solutions Inc. 1990-1992. All Rights Reserved) readonly def /FullName (Symbol) readonly def /FamilyName (Symbol) readonly def /Weight (Regular) readonly def /ItalicAngle 0.000000 def /isFixedPitch false def /UnderlinePosition -109 def /UnderlineThickness 49 def end readonly def /FontName /SymbolMT def /PaintType 0 def /StrokeWidth 0 def /FontType 1 def /FontMatrix [0.001 0 0 0.001 0 0] def /FontBBox {0 -220 1113 1005} readonly def /Encoding 256 array dup 0 /.notdef put dup 1 /.notdef put dup 2 /.notdef put dup 3 /.notdef put dup 4 /.notdef put dup 5 /.notdef put dup 6 /.notdef put dup 7 /.notdef put dup 8 /.notdef put dup 9 /.notdef put dup 10 /.notdef put dup 11 /.notdef put dup 12 /.notdef put dup 13 /.notdef put dup 14 /.notdef put dup 15 /.notdef put dup 16 /.notdef put dup 17 /.notdef put dup 18 /.notdef put dup 19 /.notdef put dup 20 /.notdef put dup 21 /.notdef put dup 22 /.notdef put dup 23 /.notdef put dup 24 /.notdef put dup 25 /.notdef put dup 26 /.notdef put dup 27 /.notdef put dup 28 /.notdef put dup 29 /.notdef put dup 30 /.notdef put dup 31 /.notdef put dup 32 /space put dup 33 /exclam put dup 34 /universal put dup 35 /numbersign put dup 36 /existential put dup 37 /percent put dup 38 /ampersand put dup 39 /suchthat put dup 40 /parenleft put dup 41 /parenright put dup 42 /asteriskmath put dup 43 /plus put dup 44 /comma put dup 45 /minus put dup 46 /period put dup 47 /slash put dup 48 /zero put dup 49 /one put dup 50 /two put dup 51 /three put dup 52 /four put dup 53 /five put dup 54 /six put dup 55 /seven put dup 56 /eight put dup 57 /nine put dup 58 /colon put dup 59 /semicolon put dup 60 /less put dup 61 /equal put dup 62 /greater put dup 63 /question put dup 64 /congruent put dup 65 /Alpha put dup 66 /Beta put dup 67 /Chi put dup 68 /Delta put dup 69 /Epsilon put dup 70 /Phi put dup 71 /Gamma put dup 72 /Eta put dup 73 /Iota put dup 74 /theta1 put dup 75 /Kappa put dup 76 /Lambda put dup 77 /Mu put dup 78 /Nu put dup 79 /Omicron put dup 80 /Pi put dup 81 /Theta put dup 82 /Rho put dup 83 /Sigma put dup 84 /Tau put dup 85 /Upsilon put dup 86 /sigma1 put dup 87 /Omega put dup 88 /Xi put dup 89 /Psi put dup 90 /Zeta put dup 91 /bracketleft put dup 92 /therefore put dup 93 /bracketright put dup 94 /perpendicular put dup 95 /underscore put dup 96 /radicalex put dup 97 /alpha put dup 98 /beta put dup 99 /chi put dup 100 /delta put dup 101 /epsilon put dup 102 /phi put dup 103 /gamma put dup 104 /eta put dup 105 /iota put dup 106 /phi1 put dup 107 /kappa put dup 108 /lambda put dup 109 /mu put dup 110 /nu put dup 111 /omicron put dup 112 /pi put dup 113 /theta put dup 114 /rho put dup 115 /sigma put dup 116 /tau put dup 117 /upsilon put dup 118 /omega1 put dup 119 /omega put dup 120 /xi put dup 121 /psi put dup 122 /zeta put dup 123 /braceleft put dup 124 /bar put dup 125 /braceright put dup 126 /similar put dup 127 /.notdef put dup 128 /Euro put dup 129 /.notdef put dup 130 /.notdef put dup 131 /.notdef put dup 132 /.notdef put dup 133 /.notdef put dup 134 /.notdef put dup 135 /.notdef put dup 136 /.notdef put dup 137 /.notdef put dup 138 /.notdef put dup 139 /.notdef put dup 140 /.notdef put dup 141 /.notdef put dup 142 /.notdef put dup 143 /.notdef put dup 144 /.notdef put dup 145 /.notdef put dup 146 /.notdef put dup 147 /.notdef put dup 148 /.notdef put dup 149 /.notdef put dup 150 /.notdef put dup 151 /.notdef put dup 152 /.notdef put dup 153 /.notdef put dup 154 /.notdef put dup 155 /.notdef put dup 156 /.notdef put dup 157 /.notdef put dup 158 /.notdef put dup 159 /.notdef put dup 160 /.notdef put dup 161 /Upsilon1 put dup 162 /minute put dup 163 /lessequal put dup 164 /fraction put dup 165 /infinity put dup 166 /florin put dup 167 /club put dup 168 /diamond put dup 169 /heart put dup 170 /spade put dup 171 /arrowboth put dup 172 /arrowleft put dup 173 /arrowup put dup 174 /arrowright put dup 175 /arrowdown put dup 176 /degree put dup 177 /plusminus put dup 178 /second put dup 179 /greaterequal put dup 180 /multiply put dup 181 /proportional put dup 182 /partialdiff put dup 183 /bullet put dup 184 /divide put dup 185 /notequal put dup 186 /equivalence put dup 187 /approxequal put dup 188 /ellipsis put dup 189 /arrowvertex put dup 190 /arrowhorizex put dup 191 /carriagereturn put dup 192 /aleph put dup 193 /Ifraktur put dup 194 /Rfraktur put dup 195 /weierstrass put dup 196 /circlemultiply put dup 197 /circleplus put dup 198 /emptyset put dup 199 /intersection put dup 200 /union put dup 201 /propersuperset put dup 202 /reflexsuperset put dup 203 /notsubset put dup 204 /propersubset put dup 205 /reflexsubset put dup 206 /element put dup 207 /notelement put dup 208 /angle put dup 209 /gradient put dup 210 /registerserif put dup 211 /copyrightserif put dup 212 /trademarkserif put dup 213 /product put dup 214 /radical put dup 215 /dotmath put dup 216 /logicalnot put dup 217 /logicaland put dup 218 /logicalor put dup 219 /arrowdblboth put dup 220 /arrowdblleft put dup 221 /arrowdblup put dup 222 /arrowdblright put dup 223 /arrowdbldown put dup 224 /lozenge put dup 225 /angleleft put dup 226 /registersans put dup 227 /copyrightsans put dup 228 /trademarksans put dup 229 /summation put dup 230 /parenlefttp put dup 231 /parenleftex put dup 232 /parenleftbt put dup 233 /bracketlefttp put dup 234 /bracketleftex put dup 235 /bracketleftbt put dup 236 /bracelefttp put dup 237 /braceleftmid put dup 238 /braceleftbt put dup 239 /braceex put dup 240 /.notdef put dup 241 /angleright put dup 242 /integral put dup 243 /integraltp put dup 244 /integralex put dup 245 /integralbt put dup 246 /parenrighttp put dup 247 /parenrightex put dup 248 /parenrightbt put dup 249 /bracketrighttp put dup 250 /bracketrightex put dup 251 /bracketrightbt put dup 252 /bracerighttp put dup 253 /bracerightmid put dup 254 /bracerightbt put dup 255 /.notdef put readonly def currentdict end currentfile eexec oc;jtD[2^t$cdreYjRZb@e F>" F+$l `v .H֢T)&wa{vIt%Նswg,lonrMWWIZ7p6\5JHrtPb E~1Cew|;d}Tym8 B T=:[RXz:F.V0zjQ 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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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