Inspection on 06/05/09 for Tynedale

This is the latest available inspection report for this service, carried out on 6th May 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Extracts from inspection reports are licensed from CQC, this page was updated on 21/07/2009.

Key inspection report CARE HOME ADULTS 18-65 Tynedale Ashbrooke Range Ashbrooke Sunderland Tyne & Wear SR2 7TR Lead Inspector Nic Shaw Key Unannounced Inspection 6th May 2009 10:00 Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tynedale Address Ashbrooke Range Ashbrooke Sunderland Tyne & Wear SR2 7TR 0191 5672886 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Autism North Limited William Waters Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: 2. Learning Disability, Code LD The maximum number of service users who can be accommodated is: 4 New service Date of last inspection Brief Description of the Service: Tynedale is a converted Victorian House set near a main road in the Ashbrooke area, a suburb of Sunderland. It is near to the city centre of Sunderland and main bus and metro links. The home has been modified to cater for the needs of up to 4 people who have a learning disability, specifically Autism Spectrum Disorder. Accommodation at the home consists of a second floor flat, two first floor bedrooms, one ground floor bedroom and a self contained basement flat. There is a spacious dining area, lounge and kitchen, also located on the ground floor. There are enclosed gardens at the back of the house. And a car park, with a secure buzzer entry system, at the front of the house. The weekly charges have not as yet been agreed. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people using this service experiences good quality outcomes. Although this home has been registered since November 2008, at the time of our inspection it had only been open for 4 weeks. There is currently only one person living here. Before the inspection visit: We looked at: Anything we have found out about the home since it was first registered in November 2008. How the manager has dealt with any complaints and concerns. What the manager thinks about the home. The visit: We visited the home on the 6th May 2009. During this visit we: Looked at the care plan to see how well the staff meet the needs of the person living here. Looked at other records which must be kept, like staff files. Checked that the staff have had good training to meet the needs of the people they care for. Talked to the manager, staff and service user and visiting relatives. Spent some time watching how staff communicated and supported the service user. We told the manager what we found at the end of the inspection. What the service does well: Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 6 There is good information about the home. want to move here. This helps people decide if they The manager always makes sure he finds out about peoples needs before they move into Tynedale. This helps to make sure Tynedale is the right place for them to live. Care plans are very good. They tell staff about the best way to support the service users. There are also good risk assessments. This is important as they show how staff help service users to be independent. There are lots of activities available, if people want to take part in them. There are good recruitment policies and procedures which help to make sure only the right people are employed to work in the home. There is a good complaints procedure. Service users are protected from abuse by staff training. The home is clean. There are always lots of staff on duty to go with people on trips out. Staff training is very good. The manager is very good and works hard to make sure service users receive an excellent service. Staff said “I love the training” and “you really feel part of a team”. Relatives said “we are delighted with the home”. What has improved since the last inspection? This was the home’s first inspection. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4&5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are provided with good information about what they can expect once they have moved into Tynedale. This ensures that their rights are protected. Generally good assessment processes ensure that potential service users needs can be met at Tynedale. EVIDENCE: There is a Statement of Purpose which gives clear relevant information about the home. This is available with pictures to help service users understand the information. Before a prospective service user can move to the home the manager visits them in their current place of residency. He also meets with family and care managers so he can collect information about the prospective service users health and personal care needs, likes and dislikes. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 10 The service user living in the home has a social worker, however, there was no social work assessment or copy of their care plan on file, which is important as part of a thorough assessment process. In order to make the move to the home as pleasant as possible the manager also arranges for staff to visit the prospective service user. After this a number of trail visits to Tynedale are arranged with those staff on duty. We spoke to relatives who said they were very happy with how settled their family member was in this home, given that they had only been living here for 4 weeks. There is a license agreement. This needs to be signed by all relevant people once the weekly fee has been agreed. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7&9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide staff with good information about how each individuals care needs are to be met. Service users are supported to take risks and make choices in their daily lives. This enables service users to lead independent lifestyles. EVIDENCE: The care plan we looked at had been developed based upon the home’s detailed up-to-date assessment. The care plan is person centred and focuses upon the individuals strengths and personal preferences. It includes excellent detailed information about what is important to the service user, particularly in relation to their morning and evening routines and personal preferences. Relatives had been closely involved in developing the care plan. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 12 There is a keyworker system in place and a “keyworker file” and this helps staff to contribute to the development of the care plan. The manager has begun to complete a communication profile. This is important so staff know the best way to help people to make choices and decisions for themselves. Staff recognize that service users may make choices, for example to go horse riding or trampolining, which have a degree of risk. In such situations the manager confirmed detailed risk assessments would be completed. A comprehensive risk assessment had been completed for using the home’s transport with measures in place to reduce the risk. This is important so that service users can enjoy outings in the local community. Tynedale has a can do attitude. This was evident in the way the care plans are written with an emphasis upon the persons strengths and how staff should support and encourage independence. For example; what service users are able to do for themselves at mealtimes. Where there are limitations, this was clearly recorded in the care plans. It is the policy of the home to monitor and evaluate care plans every month. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,14,15,16&17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for service users to take part in a range of activities both inside and outside the home are good. Service users are assisted to maintain links with their family and to have a community presence. This enables them to lead a full and enjoyable life. Service users are provided with a healthy, varied diet which helps to promote their general health and well being. EVIDENCE: Autism North provide service users with a range of activities including swimming, horse riding and trampolining. It is the aim of the home to encourage and support service users to experience new and different activities in the community. This is achieved by setting small goals. With staff support Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 14 service users are able to gain confidence by achieving each small goal set. For example, a goal has been set for the service user to have the confidence to get out of the bus when on an outing. Staff are working with them to achieve this so that eventually they can enjoy activities such as swimming. When we visited there were 2 staff on duty. This is so that the service user can be supported to achieve their social activity goal. It is the home’s policy for service users to enjoy a holiday of their choice each year. The home has its own transport. When we visited staff interacted with service users. Everyone sat together either in the lounge or around the dining table and the service user was included in the conversation that took place. The service actively encourages and provides opportunities for service users to develop communication and social skills. This is recorded in the care plans with the communication profile. Relatives are able to visit their family member whenever they want to. They said that they were made to feel very welcome when they visited. The home offers healthy home cooked meals. The menu is based on the service user’s likes and dislikes. The support the service user requires at mealtimes is clearly recorded in their care plan. Staff were very knowledgeable about the specific support the service user requires at mealtimes, how to encourage them to come to the dining area and their likes and dislikes. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19&20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for meeting the personal and health care needs of people using the service are good. And service users receive the support they need from staff to ensure that their personal, physical and emotional needs are met. The service users are protected by the homes medication policies and procedures. EVIDENCE: There is detailed guidance available in the care plans so that staff know the most appropriate way to support service users in the way they prefer. Personal health care needs, including specialist health requirements, are clearly recorded in the care plan. They give a comprehensive overview of a persons health needs. An OK health check has been completed and the manager confirmed that this is reviewed each year. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 16 Where service users have complex needs, in terms of their behaviour, there are detailed behaviour care plans in place. These are regularly reviewed and up-dated. Daily records are maintained which include monitoring a person’s behaviour and “mood”. There are policies and procedures available about medication. All staff who will be expected to administer medication have been provided with training in this area. Currently there is no medication kept in the home, however, there is an area available to store medication safely. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22&23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst service users communication is limited, arrangements are in place through the complaints procedure to promote their safety and offer protection. Appropriate policies and procedures are in place, supported by staff training, which ensure that service users are protected from abuse and neglect. EVIDENCE: The homes complaints procedure provides service users and relatives with guidance about how to complain. There is an easy read version available for service users. The manager told us, in information we asked for before the inspection, that there have been no complaints since the home first registered. Relatives said that they would complain if they were not happy with the service provided. The homes safeguarding policy provides staff with guidance about how to handle adult protection concerns. There have been no safeguarding referrals made since the home registered. This is as a result of lack of incidents rather than a lack of understanding about what incidents should be reported. The manager has obtained a copy of the local authority safeguarding policy and procedure and has completed training in relation to this. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 18 Some of the staff have completed training in safeguarding adults. Arrangements are in place for the remainder of staff to complete this training later this year. Appropriate records are kept of financial transactions made on behalf of the service user. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29&30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a safe, clean, well-maintained environment which meets their needs. EVIDENCE: There is plenty of communal space at Tynedale with a lounge, separate dining room, kitchen, conservatory, toilet, conservatory and one bedroom on the ground floor. The first floor consists of two bedrooms and laundry area. All bedrooms are spacious, single occupancy with en-suite facilities. The service user living here was able to choose their bedroom before they moved in. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 20 On the first floor is a spacious self contained flat, which includes a lounge, dining room, bedroom, an area for preparing refreshments and a bathroom. The home is clean and tidy and smells fresh. A senior member of staff has been given the responsibility of ensuring maintenance checks are completed. There is a spacious enclosed garden at the back of the house and a large forecourt at the front. Two staff have completed training in infection control and arrangements are in place for the remaining staff to undertake this training. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34&35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training and staffing levels are good and ensure that service users receive person centred care. The staff recruitment policies and procedures fully protect the service users. EVIDENCE: When we arrived there were 2 staff on duty, which is good as there is currently only one person living in this home. This meant that on that day the service user could enjoy a trip out in the home’s transport, an important daily activity for them. There are also always 2 nightstaff on duty. The manager said that he will gradually increase staffing levels as the number of service users increases. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 22 The staff we met had confidence in their work and understood the needs of the service user and the best way to support them. Staff said the training was excellent. In addition to the NVQ level 2 and NVQ level 3 qualification in care and induction training, care staff have completed training in prevention and management of violence, care planning, autism awareness, equality and diversity and handling people with special needs. The manager has developed a training needs analysis. This is used to identify where there are gaps in knowledge so that he can arrange for the relevant training for staff. Staff files demonstrated that a good recruitment procedure is followed. As well as potential applicants being asked to complete a job application form and take part in an interview, an Enhanced Criminal Records Bureau (CRB) check is obtained for all staff before they are able to work in the home. This includes ensuring that that the Protection of Vulnerable Adults (POVA) list is also checked. The POVA list is a list of people considered unsuitable to work with vulnerable adults. Two written references are also sought. In one staff file we looked at the CRB check was not available. The manager confirmed that this was because this person had transferred to Tynedale from another home within the organisation. He agreed to obtain proof of the CRB check for his own records. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39&42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well-managed service. There are good quality assurance systems in place to ensure good standards of care are maintained and to assure service users and their relatives that their views are listened to. EVIDENCE: The manager is in the process of completing the NVQ level 4 qualification in care and has a number of years experience of management as a deputy manager. Staff said about the manager “Bill is great, I have learnt a lot from Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 24 him”. It was evident that the manager communicates a clear sense of direction and an excellent understanding of best practice. He has a good rapport with both the service users and their relatives. The Annual Quality Assurance Assessment (AQQA), this is the information we ask for before an inspection, contains clear information, however, was a little brief and could be supported further by a wide range of evidence that clearly supports the claims made. Risk assessments are completed in relation to all health and safety issues. These include risk assessments and control measures relating to activities both inside and outside the home. All staff have completed training in health and safety, such as first aid, fire safety and moving and handling. There is also a good quality assurance system in place. This involves regular internal audits to ensure care standards are maintained and/or improved. For example, the completion of maintenance checks to make sure service users continue to be provided with a safe environment. Although the service user has only been living in Tynedale for one month they have been supported to complete a questionnaire about what they think of the home. There are a wide range of policies and procedures and these are regularly reviewed and up-dated by the company. Appropriate records are kept of accidents and incidents. Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 3 3 3 X Version 5.2 Page 26 Tynedale DS0000072986.V375394.R01.S.doc N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA2 Good Practice Recommendations The manager should obtain a copy of the social work assessment and care plan. This will help him to find out if Tynedale is able to meet the needs of prospective service users. The license agreement should be signed by all relevant people and information about the weekly fees should be available in here. This is so that people know what their rights are. 2 YA5 Tynedale DS0000072986.V375394.R01.S.doc Version 5.2 Page 27 Care Quality Commission North Eastern Region Citygate, Gallowgate Newcastle upon Tyne NE99 5AS National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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